CONDITIONS EXPLAINEDSpondylolisthesis
CONDITIONS EXPLAINEDSpondylolisthesis
Characterized by the slippage of one vertebra over another, spondylolisthesis is a condition in which the vertebra or supporting structures are compromised, and overcome by the stresses on the vertebral column. It is divided broadly into three categories based on etiology:
- Congenital Spondylolisthesis is present at birth
- Isthmic Spondylolisthesis occurs due to inadequacy of supporting structures, due to some defect such as fracture
- Degenerative Spondylolisthesis involves the degeneration of supportive structures, such as the degeneration of the intervertebral discs commonly experienced with advancing age
The intervertebral discs act as shock absorbers between vertebrae, and absorb much of the vertical forces affecting the spine. Supporting structures absorb horizontal stresses, but can fail if the stress is too great. Any uncompensated excess of stress can lead to slippage over time. Individuals most commonly affected are those with a family history of the condition, as well as those who repeatedly experience exceptional stresses on the spine, such as gymnasts and weight lifters.
Symptoms of this condition may include:
- Pain in the lower back, buttocks, and thighs
- Difficulty with bowel and bladder control
- Waddling gait
- Tight hamstrings
Experiencing Symptoms of Spondylolisthesis?
Detection & Diagnosis
X-ray is the gold standard for diagnosis of spondylolisthesis, as the vertebral slippage is clearly visible on imaging. Slippage is graded on the degree to which the vertebra has shifted.
- Grade I: Less than 25% slip
- Grade II: 25-49% slip
- Grade III: 50-74% slip
- Grade IV: 75-99% slip
- Grade V: The most severe form, in which a vertebra has completely fallen off the level below it. This is termed spondyloptosis.
OUTCOMESRelated
Treatments & Procedures
Treatment for spondylolisthesis depends on severity, but is usually first approached with non-surgical interventions, such as:
- Lifestyle changes, exercise, weight loss
- Physical therapy, in which special stretches may reduce pain and aid in recovery, and better motions for commonly problematic tasks may be taught to prevent exacerbation of existing problems. In addition, strengthening core muscles helps to compensate for spinal insufficiency.
- Several pharmacological treatments exist including the use of non-steroidal anti-inflammatory drugs such as aspirin or ibuprofen, steroids for long term relief, and stronger narcotics for pain that does not respond to existing pain management. In the case of steroids, an injection is typically made at the level of the problematic structure, limiting inflammation for months at a time and allowing time for recovery.
In some cases, surgery will be necessary, and typically involves the fusion of vertebrae to stabilize the spinal column.
- Anterior Lumbar Interbody Fusion is an open and invasive procedure in which a problematic intervertebral disc is removed, and the adjoining vertebrae are fused with a bone graft and implanted hardware for stabilization
- Minimally Invasive Lumbar Fusion may be performed as an outpatient procedure, and is less traumatic to local tissues, providing faster recovery times, reduced risk of infection, and a reduced risk of complications associated with open surgery
Anterior Lumbar Interbody Fusion
Anterior Lumbar Interbody Fusion (ALIF) is a procedure performed from the anterior to fuse vertebrae into a single structure. This technique is usually favored when..
Artificial Disc Replacement
Artificial disc replacement is a procedure with the goal of removing a painful intervertebral disc and replacing it with a prosthetic one. Spinal fusion is much more commonly performed..
Decompression (Laminectomy)
Decompression Lumbar Laminectomy is the most common surgical procedure performed for the correction of stenosis in the back. The surgeon will remove or trim the bony lamina and a thick ligament..
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