Spondylolisthesis most commonly affects the lower back or the lumbar spine. It's a condition where one vertebra slips over the other which leads to pinching of the spinal nerves causing numbness or pain in the back or legs. Spondylolisthesis is quite a painful condition but treatable in many cases. Both nonsurgical and surgical methods may be used for spondylolisthesis treatment.
Types of Spondylolisthesis
• Congenital spondylolisthesis: The patient is born with an abnormality of the posterior bony arch of the spine, which causes the slippage. Commonly associated with abnormality of the facet joints. • Isthmic/Lytic spondylolisthesis: A defect in a part of the vertebra called the pars interarticularis. This is the result of a stress fracture in individuals with genetic predisposition. This condition can be painful. • Degenerative spondylolisthesis: Caused by forward slippage secondary to arthritis of the spine. Usually linked with spinal stenosis. Caused by long-standing degenerative disc disease leading to weak facet joints.
Symptoms of Spondylolisthesis
• Persistent pain in the lower back • Stiffness in your back and legs • Lower back tenderness • Thigh pain • Tight buttock muscles and hamstrings • Pain in legs while standing or walking (in moderate to severe cases) Mild spondylolisthesis cases may not present any symptoms.
Causes of Spondylolisthesis
Spondylolisthesis has a variety of causes depending on age, genetics, and lifestyle. Children can suffer from spondylolisthesis as the result of a birth defect or injury. Sports which cause strain due to overstretching or excessive stress on the lower back can lead to spondylolisthesis: • Football and gymnastics • Track and field and weightlifting • Basketball, ballet, and dancing • Fast pace bowling
How To Diagnose Spondylolisthesis
• Physical examination: Pain on firm pressure over the low back; at times a step may be felt due to forward slipping of one vertebra over the other. • X-ray: Helps diagnose and grade severity. Dynamic views diagnose abnormal mobility. Whole Spine X-rays help understand global spinal alignment. • CT Scan: Provides details of the bony anatomy. • MRI: Shows the amount of nerve compression and neural anatomy. • Bone Scan: In doubtful cases, helps diagnose occult spondylolysis and stress fractures.
Treatment Options for Spondylolisthesis
Non-Surgical Treatment: A lot of patients respond well to non-operative treatments: • Wearing back braces • Physiotherapy and core strengthening • Anti-inflammatory drugs to reduce pain • Epidural steroid injections to reduce severity of back and leg pain Surgical Treatment: In severe spondylolisthesis or patients not responding to non-operative treatment, surgery can be an excellent treatment method. The aim of surgery is to safely restore spinal alignment and stability, decompress spinal nerves and promote spinal fusion. Surgical options include: • Transforaminal Lumbar Interbody Fusion (TLIF) • Minimally Invasive TLIF (MIS-TLIF) • Anterior Lumbar Interbody Fusion (ALIF) • Oblique Lumbar Interbody Fusion (OLIF) Recovery: Patients are made to stand and walk on the same or next day. Patients go home 3–4 days after surgery. Return to work: 3–6 weeks. Return to sports: 3–6 months.