Spondylolisthesis causes, symptoms, treatment
Description of spondylolisthesis causes
“Spondylolisthesis” is a term used to describe vertebral slippage. A spondylolisthesis diagnosis is characterized by the displacement of one vertebra over another, and slippage can occur in any direction. Spondylolisthesis is found most frequently within the lumbar (lower back) region of the spine. This is due to the fact that this area is exposed to a great deal of pressure caused by the movements associated with lifting heavy objects and twisting the torso. The lumbar region also bears most of the weight of the upper body. Gymnasts, weightlifters, football players, hockey players and other athletes are especially susceptible to this condition because of the tremendous amount of stress they place on their lower backs. But, even though the condition is seen frequently in athletes, spondylolisthesis can also be inherited or present at birth (a congenital condition), an effect of aging or a result of an injury or trauma to the spine.
Spondylolisthesis symptoms and diagnosis
The symptoms of spondylolisthesis include tightness or stiffness in the back muscles, pain in the thighs and buttocks and pain in the area of the spine where the slippage occurred. Grades are used to classify the condition, with a grade 1 spondylolisthesis diagnosis signifying the least amount of slippage and a grade 5 representing 100 percent slippage. The less slippage there is, the less likely that the associated symptoms will become debilitating. However, even a minor displacement of a vertebra can cause nerve impingement and chronic pain.
Symptoms might be experienced at the actual site of the spondylolisthesis or they can develop in an apparently unrelated area of the body. Pain and stiffness are most common at the site of the vertebral slippage, but if a displaced vertebra makes contact with (compresses) a nearby nerve root, a set of neurological symptoms known as radiculopathy could be produced. Radiculopathy is characterized by radiating pain, tingling, numbness and weakness or loss of function in the group of muscles that are innervated by the compressed nerve root. The areas affected by nerve compression symptoms will depend on the location of the vertebral slippage. Vertebral displacement in the lower back could lead to symptoms that are felt in the buttocks, legs, feet and toes, while spondylolisthesis in the cervical (neck) region can affect the shoulders, arms, hands and fingers. Regardless of its location, the condition can also lead to spinal cord compression, which could result in myelopathy, which is characterized by severe loss of muscular function or even paralysis in the lower body.
To reach a diagnosis of spondylolisthesis, a physician may use an imaging scan to confirm the presence of vertebral slippage. The slippage will then be assigned a grade of 1 to 5, which will help determine the type of treatment necessary.
Treatment prescribed for spondylolisthesis varies. To recommend a treatment plan, a patient’s physician will assess the severity of the condition and the symptoms it is causing, as well as the overall health of the patient. A physician often will first recommend a variety of conservative treatments, such as:
- Medications — Anti-inflammatory drugs and pain medications can both be very helpful in the management of spondylolisthesis symptoms. Patients have several over-the-counter options, such as ibuprofen and acetaminophen, or they may request a stronger prescription if OTC medications are not effective.
- Epidural spinal injections — In addition to oral medications, injected medications can also help minimize pain and inflammation caused by spondylolisthesis. Injections can be given individually or as a series, although there is typically a limit on the number of these treatments a patient can receive over the span of a year. Nerve block injections can also be administered to temporarily desensitize the nerves that are transmitting the pain signals.
- Physical therapy — Targeted exercises can be highly beneficial for patients with spondylolisthesis. A professional physical therapist can recommend a series of strengthening exercises, isometric and isotonic exercises, muscle stretches and balance-enhancing techniques to minimize back pain and other spondylolisthesis symptoms while helping the patient build up muscle mass and increase flexibility in the body.
- Low-impact exercise — Walking, swimming and similar gentle exercises can help improve circulation and expand a patient’s range of motion. However, a patient should be careful to avoid harsh motions or movements that impact the spine (such as running or contact sports), which can make spondylolisthesis symptoms worse.
- Alternative care — Although the following options are less traditional than medications and exercise, therapies such as acupuncture, yoga and chiropractic adjustments can be helpful in the management of spondylolisthesis pain.
Most patients are instructed to use these therapies for several months, testing various combinations of conservative treatments to find an effective routine. This can take a bit of trial and error, although most patients are able to develop a spondylolisthesis management plan with the assistance of their physicians. If, however, conservative treatments do not produce the desired results, a physician may eventually recommend surgery to help the patient obtain more meaningful symptom relief.
Surgery for spondylolisthesis
If surgery becomes a consideration, a patient may have several options to explore. For instance, open back surgery may be a treatment option for nerve compression, although minimally invasive alternatives may offer more benefits, such as expedited recovery times and lower complication rates.
At Laser Spine Institute, we offer several minimally invasive decompression procedures that may be effective for patients with spondylolisthesis and other degenerative spine conditions. For instance, a patient may consider:
- A foraminotomy, during which a surgeon removes bone matter and tissues that are compressing a nerve in the spinal canal
- A laminotomy, during which a surgeon removes part of the lamina (the arch that goes over the top of the spinal canal) to help alleviate spinal cord impingement
- A discectomy, during which a surgeon removes herniated or bulging disc material that is pressing on a nerve or nerve root
- A facet thermal ablation, during which a surgeon deadens a nerve ending and cleans a facet joint to reduce pain and other symptoms
Laser Spine Institute also performs several minimally invasive stabilization procedures which can be helpful in securing a slipped vertebra back into its proper position. Our spondylolisthesis surgeries are performed on an outpatient basis, which enables patients to leave our facility the same day as their surgery and recover from the procedures in the comfort of their own homes. For more information, contact us with your questions. We also can review your recent MRI to determine your eligibility for one of our minimally invasive spondylolisthesis procedures.