Spondylolisthesis is a condition that describes the misalignment of the vertebrae in the spine. Often for patients with this condition, a vertebra in the spine will slip due to injury or other spine condition and will move out of the natural alignment of the spine. This could result in pain, stiffness, and limited mobility in certain areas of the spine.
Spondylolisthesis occurs when the vertebrae of the spine move out of their natural alignment. This condition usually occurs in the lumbar (lower back) portion of the spine due to the natural compression of the spine over time.
The spine is comprised of several small bones, called vertebrae, stacked on top of each other. In between each vertebra is a small, sponge-like disc that serves to cushion the vertebrae and allow mobility. Also located in between the vertebrae are joints made up of soft tissue. The joints allow the vertebrae to bend and move, ultimately allowing your spine to have a range of motion.
While some spondylolisthesis causes are unavoidable, there are activities that can put you at a higher risk for a slipped vertebra. Gymnasts, weightlifters and football players are especially vulnerable to spondylolisthesis because so much pressure is placed on their backs, particularly the lower back.
Other spondylolisthesis causes include:
- Fractures —Spondylolisthesis is often caused by small fractures to the joints in the spine. This can cause a vertebra to become unhinged and slip forward. The fractures can be partial or complete, and sometimes fragments of bone are broken off, which can cause a pinched nerve.
- Aging — As the body ages, the spinal discs dry out, making them less capable of handling movement and absorbing shock. As a disc loses its ability to act as a cushion, it increases the chance that a vertebra will slip forward.
- Tumors — Tumors can weaken bones, causing fractures and potentially leading to a vertebral slip.
- Surgery — Slippage can result from a back surgery; however, it is rare.
- A birth defect — It is possible to be born with a defective joint that can increase the risk of developing spondylolisthesis
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.
To understand how to avoid spondylolisthesis requires a closer look at the potential causes of the condition. In general, vertebral slippage is most commonly caused by:
- Congenital defect — this means the condition is present at birth
- Pathological damage — caused by tumor, disease or bone abnormality
- Injury — bone damage caused by major injury or fracture to the vertebra, as well as gradual damage caused from high-impact sports
- Osteoarthritis — cartilage degeneration in the spinal column caused by arthritis
Spondylolisthesis risk factors can be summarized into two categories: risks you can avoid and those you can’t. While you have no control over congenital defects or pathological problems, avoiding activities that put undue stress on your spine and practicing good spine health can help limit your chances of developing the disorder.
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:
- 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.
- 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.
- 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.
- 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.
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