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Spondylolisthesis – Types, Symptoms and Treatment

This tongue- twister called spondylolisthesis is derived from Greek words spondylos, meaning ‘spine’ or ‘vertebra’ (spinal bone), and listhesis, meaning ‘to slip’ or ‘to slide’. Spondylolisthesis is a type of spinal deformity where one vertebra (spinal bone) is displaced over the one below it.

What is spondylolisthesis?

Spondylolisthesis is a spinal condition in which, one of the spinal bones (vertebrae) slips over the vertebra below it. If the vertebra slips excessively, the bone may press on a nerve, which causes pain. Generally, spinal bones of the lower back are affected.

The displacement, if forward, is called anterolisthesis and if backward, is called retrolisthesis. This problem generally occurs in the lower back or lumbar spine between the last two lumbar vertebrae (L4 – L5) or between the last lumbar and first sacral vertebra(L5-S1). Spondylolisthesis is responsible for causing narrowing of the spinal canal or compression of the nerves exiting at that level.

Types of spondylolisthesis

There are five types of spondylolisthesis as listed below. The risk of developing it increases if there is a family history of backache or in athletes like gymnasts, weight lifters and football linemen whose spines are subjected to large forces repeatedly.

  • Dysplastic

    This is a congenital condition in which there is a defect during the formation of the vertebra.

  • Isthmic

    This is the most common type in which the front portion of the vertebra gets separated from the back portion. This is often seen in sportsmen who tend to over-extend the lower back like gymnasts and football linemen.

  • Degenerative

    This is common in elderly people because of osteoarthritis. The slippage may be forwards or backwards. The displacement is not severe and does not usually cause neurological problems.

  • Pathological

    It occurs due to a weakened bone for e.g. if there is a tumour.

  • Traumatic

    This is a very rare type due to a back injury.

Symptoms and signs of spondylolisthesis

  • The most important symptom is pain in the lower back which gets worse after exercises, especially those which cause over-extension of the lower spine.
  • There may be a decrease in the range of motion of the lower back and tightness of the hamstrings.
  • Neurological symptoms like pain, numbness, tingling and weakness in the legs due to nerve compression.
  • In some severe cases there may be loss of bladder or bowel control.

Diagnosis of spondylolisthesis

The physician may suspect spondylolisthesis after taking the patient’s history and examination. It can be confirmed by X-rays of the lumbar spine in the lateral view. The severity of the condition is described by grading it from one to five where one is considered mildest and five is the most severe.

Treatment of spondylolisthesis

The treatment options are conservative and surgical. In mild and uncomplicated cases, rest is prescribed while athletes are advised to discontinue exercises for some time. Anti-inflammatory drugs are prescribed for backache and specific exercises help to strengthen the abdominal muscles. If a patient has symptoms of tingling, epidural steroid injections are of value. In athletes a special brace can be worn which extends the lumbar spine and promotes fusion of the two bones.

Surgery: Surgery is done depending on the grade of the condition and if the bone is active. In some cases a bone graft has to be put in, fitted with screws. If the nerves are compressed, decompression is carried out and the area around the nerves is cleared. The surgeon takes a call to join the vertebrae (lumbar fusion) in the original position or in the new position after the bone has slipped.

Prevention of spondylolisthesis

Spondylolisthesis cannot be completely prevented. However, there are some steps to reduce the risk of slips:

  • Maintain a healthy weight. Overweight or excess weight may add stress on your lower back
  • Keep your abdominal muscles and core strong. This will help support and stabilize lower back.
  • Choose only those sports or activities that do not place the lower back at risk for injury. Biking and swimming are potential options
  • Eat a well-balanced diet to help keep bones well-nourished and strong.
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