It is a type of spinal instability that cause pain in the lower back. This happens when one vertebrae, bone of your spine, slips over the below vertebra. Most of the time, non-surgical treatment can relieve your spondylolisthesis symptoms but if you have severe spondylolisthesis, surgery is the only option left, and the results are quiet promising.
It accounts for about 4-6% of the population. Many are asymptomatic and are diagnosed as an incidental finding. Degenerative spondylolisthesis is the commonest occurring in patients more than 50 years of age and is a sequel ea of degenerative spine disease. In young population isthmic is common.
There are six main types of spondylolistheses. The type is determined by the cause which include:
Congenital spondylolisthesis: Vertebrae are deformed from birth.
Isthmic spondylolisthesis: The reason for this is another condition called spondylolysis. In spondylolysis, a fracture, or crack, in the important part of a vertebra (pars interarticularis) can cause the vertebrae to fall back or forward over the underlying bone.
Degenerative spondylolisthesis: As time goes, the intervertebral disk loose its water content and elasticity, making it more rigid and thinned out. As a result of which they might slip over one another
Traumatic spondylolisthesis: Injury or trauma makes a vertebra slip.
Pathological Spondylolisthesis: Another condition such as osteoporosis or cancer is the cause.
Post-surgical spondylolisthesis: The vertebrae move out of place after surgery.
Different grades of spondylolisthesis:
Low Grade (Grade 1 & 2): These patients mostly, can be treated conservatively. These mainly include the adolescent isthmic and degenerative spondylolisthesis.
High Grade (Grade 3&4): These patients mostly all require surgery.
Symptoms of spondylolisthesis:
Most of the patients are asymptomatic. Other symptoms include:
- The pain in lower back
- muscle tightness and stiffness
- Pain in the buttocks
- Pain radiating down the leg (due to pressure on the nerve roots)
- The pain worsens with activity
- Leg muscles cramps
- Difficulty standing or walking
Diagnosis of spondylolisthesis:
If your doctor thinks you may have spondylolisthesis, they will ask about your symptoms and do an imaging test to see if a vertebra is out of place. These imaging tests may include:
- Radiography X-Ray
- Computed Tomography
Your doctor can give you a note depending on the severity of spondylolisthesis. The low grade (I or II) is less serious and generally does not need surgery. Higher levels (III and IV) are more serious. You may need surgery, especially if you are in a lot of pain.
Treatment of Spondylolisthesis:
Spondylolisthesis treatment is done by strengthening the abdominal and back muscles and supporting strength through physical therapy. Treatment may include:
- Take rest
- Anti-inflammatory medications
- Steroids injections
- Physical therapy
If you continue to experience severe pain and disability after physical therapy, surgery may be an option.
How do I know if I need surgery for spondylolisthesis?
You may need surgery if you have advanced spondylolisthesis, the pain is severe, or you have tried non-surgical treatments without success.
The goals of spondylolisthesis surgery are:
- Relieve pain from irritated nerves.
- Stabilize the spine
- Restore your function.
In surgery, we decompress the nerve root and then do a fusion of the two involved vertebrae to stabilize the spine.
If you are a patient suffering from spine issues or injuries consulting a spine specialist would be the best option. Dr Vishal Bhasme is leading spine specialist in Pune, his methodology of spondylolisthesis treatment begins from an accurate diagnosis.
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