What are the other Names for this Condition? (Also known as/Synonyms)

• Spondylolisthesis (Disorder)

What is Spondylolisthesis? (Definition/Background Information)

Spondylolisthesis is an extremely painful and traumatic injury that involves a vertebra in the spine, which slips forward out of its normal position, resulting in abnormal pressure on the nerve roots.

There are many types of Spondylolisthesis condition. Some of the less common types are spinal slippages that result from a severe fracture or a tumor. However, three common types include Congenital, Degenerative, and Spondylolytic Spondylolisthesis.

• Congenital Spondylolisthesis (Dysplastic Spondylolisthesis): Congenital Spondylolisthesis (present at birth) is the direct result of a bone formation abnormality, which increases the risk of the vertebra slipping forward
• Degenerative Spondylolisthesis (DS): Degenerative Spondylolisthesis occurs when a vertebra in the spine, slips forward out of its regular position, due to a normal wear and tear associated with aging. This may cause the nerve root to pitch. Women are more likely to develop this condition than men. There is also an increased presence of this condition amongst African-Americans
• Spondylolytic Spondylolisthesis (Isthmic Spondylolisthesis): Spondylolytic Spondylolisthesis occurs when one of the bones within the lower back fractures, resulting in the vertebra slipping forward. This may also cause the nerve roots to pitch. This type of fracture is predominantly seen in the lumbar spine, at a location called pars interarticularis (a bony bridge in the vertebra)

Who gets Spondylolisthesis? (Age and Sex Distribution)

• Individuals of all gender, age, and racial/ethnic groups, may develop Spondylolisthesis
• However, the disorder mostly develops in adolescent-adult men and women, between the ages 16-40 years

What are the Risk Factors for Spondylolisthesis? (Predisposing Factors)

Common risk factors associated with Spondylolisthesis include:

• Rough or high-impact sports associated with athletics
• Abnormal inward curvature of part of the lumbar spine, termed as lordosis
• Postmenopausal women or inactive older individuals with a degenerative joint disease, such as osteoporosis
• Certain occupations that require excessive lifting of heavy objects
• Abnormal inflammation and damage to the cartilage that line the joints, such as due to osteoarthritis
• Traumatic injury to the spine caused by an automobile accident
• Poor posture
• Excess body weight associated with obesity, which can abnormally increase the pressure on joints
• Pregnant women
• Smoking can negatively affect vertebrae water level and rapidly increase the chances of disc degeneration

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Spondylolisthesis? (Etiology)

Some of the causes associated with Spondylolisthesis include:

• An advancing age
• Congenital lumbar spinal stenosis (an abnormally narrow spinal canal, which is present at birth)
• Traumatic spinal fracture
• Performing repetitive or highly stressful activities that are associated with athletics, occupation-related

What are the Signs and Symptoms of Spondylolisthesis?

Signs and symptoms of Spondylolisthesis include:

• Excessive pain and stiffness in the lower back
• Feeling of weakness in the legs
• Tight hamstring muscle
• Numbness or a tingling sensation in the buttock or thighs
• Abnormal stiffness
• Feeling of tenderness surrounding the site of the prolapsed (slipped forward) disc
• Weakness of the legs

How is Spondylolisthesis Diagnosed?

Diagnostic methods that a physician may use to help diagnose Spondylolisthesis include:

• Physical examination: The physician will perform a thorough physician examination to assess any pain or weakness. The patient may be asked to perform minor physical tasks or actions, like leaning forward/backward, etc. In addition to this, the individual’s medical history shall be evaluated
• X-rays: X-rays are useful in showing if the lumbar bone has slipped forward and the extent of the slippage. This diagnostic test may also show if any abnormalities due to advancing age are present within the spine, such as the formation of bone spurs
• Magnetic resonance imaging (MRI): An MRI is a more detailed scan that uses radio waves and a magnetic field to generate thorough images of interior bones and soft tissues. An MRI scan can take a clearer image of the prolapsed disc and identify any compression in the spinal cord (if any)
• Computerized tomography (CT): A CT scan takes a series of x-ray images from several different angles, which are then merged to create cross-sectional images of bones and soft tissues with the body. This allows a physician to examine the spinal column and its surrounding structures
• Electromyography (EMG): An EMG shows the electrical activity of a muscle during rest and when they contract. Examining the electrical activities may help a physician observe any nerve damage, which along with other diagnostic tests, may provide very useful information about the condition
• Nerve conduction velocity (NCV): NCV shows the speed at which electrical signals move through a nerve. Slow nerve signal speed may indicate a nerve damage

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Spondylolisthesis?

Complications associated with Spondylolisthesis are:

• Chronic pain and stiffness within the lower back
• Temporary or permanent injury to the spinal roots
• Possible weight gain due to decreased physical activity

How is Spondylolisthesis Treated?

The treatment associated with Spondylolisthesis, primarily focus on relieving symptoms that are causing the pain and stiffness. Non-invasive treatment measures include:

• Physical therapy exercises that include strengthening and improving flexibility of the lower back. Proper stretching of the lower back and abdominal muscles is also advised
• Non-steroidal anti-inflammatory oral medications may be used to treat Spondylolisthesis. These medications can help decrease the pain and swelling
• Corticosteroid injections into the epidural space (region near the spine, inside the vertebral column) help provide temporary relief of symptoms, and in improving the range of motion. It is important to note that corticosteroid injections only give temporary relief. Prolonged episodes of such injections, may injure the joints in the long-run

Surgical treatment for Spondylolisthesis may be recommended, if an individual does not respond to conservative management of the condition. Individuals are advised to discuss alternatives with their physicians, before making a decision.

Common surgical procedures that help decrease compression of the spinal cord include:

• Lumbar laminectomy: This surgical procedure is intended to relieve pressure on the spinal cord and/or nerves by removing the lamina. During a lumbar laminectomy procedure, the lamina (small section of the bony roof in the spine) is removed to create additional space for the surrounding nerves within the spinal canal. A bone graft material then fills the empty space and two or more vertebrae of the lumbar spine are fused together to create stability. However, this procedure may also be performed, without a lumbar spinal fusion
• Anterior lumbar interbody fusion (ALIF): This surgical procedure is performed from the front through an abdominal incision. It involves the removal of damaged or diseased intervertebral bone and the surrounding lumbar discs. A bone graft material is then used to fill the empty space, and it is fused together with the lumbar spine

How can Spondylolisthesis be Prevented?

Spondylolisthesis disorder is a condition that is very difficult to prevent, due to a variety of risk factors being involved. However, observing certain preventive guidelines may help decrease the risk of development of the condition. These include:

• Exercising regularly
• Adequate rest between exercises, can help prevent injuries due to overuse
• Individuals, who participate in any rough, high-impact sports (like football), should wear appropriate safety equipment to help decrease the risk of developing Spondylolisthesis
• Maintaining a healthy body weight can help reduce unwanted stress on the spine

What is the Prognosis of Spondylolisthesis? (Outcomes/Resolutions)

• The long-term prognosis with Spondylolisthesis depends on the severity of the condition
• In cases where the slipped vertebrae is not pressing on any nerves, an individual may not experience a recurrence of Spondylolisthesis
• Generally, conservative treatment methods are usually successful in relieving symptoms for a high percentage of individuals, with mild Spondylolisthesis cases
• For a high percentage of individuals with a severe cases of the disorder, surgical treatment may be successful in relieving the symptoms and providing a better quality of life

Additional and Relevant Useful Information for Spondylolisthesis:

Spondylolisthesis is different from spondylolysis, which are small microfractures that occurs in part of the vertebral bones, within the spinal column.