What is spondylolisthesis?
Spondylolisthesis means slipped vertebra. It is a condition whereby over time the vertebra above slips forward over the vertebra below it. As a result of the slippage, there is less room for the nerves to travel and exit the spinal canal resulting in back and leg pain symptoms from pinched nerves. There are several types of spondylolisthesis. The most common type results from progressive arthritis of the facet joints. The second most common type of spondylolisthesis results from a bony defect in the pars interarticularis, which is the bony portion of the spine located between the facet joints.
How is spondylolisthesis diagnosed?
The most common symptom is low back pain from stress on the weakened slipped vertebra segment. The back pain typically worsens with strenuous activities such as lifting and bending. If the spondylolisthesis results in nerve compression, then there will be buttock and leg pain symptoms and potentially leg weakness and numbness. A lumbar x-ray study will show the slipped vertebra. If the symptoms are more severe, a lumbar MRI will show severity and location of nerve compression.
What is the treatment for spondylolisthesis?
The treatment options will depend on the severity of the back and leg pain symptoms. Mild symptoms are treated conservatively (nonsurgical) with medications (e.g. Tylenol, anti-inflammatories, muscle relaxants), physical therapy, and injections. The type of injection will depend on the spinal element that is causing the pain. If the pain is a result of leg pain from a pinched nerve, then an epidural injection is appropriate to deliver steroid medication to the nerve to relieve inflammation. If the pain is a result of back pain from an arthritic, weak facet joint, then a facet injection is appropriate.
Spondylolisthesis can produce severe low back and leg pain, leg weakness and difficulty with walking and interfere with activities of daily living. If conservative options have failed, then surgery is an effective treatment. The most common surgical approach to spondylolisthesis is a combination of lumbar laminectomy and spinal fusion. A lumbar laminectomy is the removal of arthritic joints and ligaments to make adequate room for the nerves. A spinal fusion is the placement of bone or bone products between two vertebra to stabilize the slipped vertebral segment. The fused segment is usually supported by titanium screws and rods known as a pedicle screw system that acts like a scaffold to hold the vertebral segments in place allowing for the bony fusion to mature.