Spondylolisthesis is when one vertebra in the spine slips forward out of place. This can make the spine misaligned and compress nearby nerves.
This nerve compression can cause symptoms such as ongoing pain, back stiffness, or tingling in the legs. Spondylolisthesis is most common in the lower back, but it can affect any part of the spine, including the neck.
The condition is often related to natural aging, which can cause the spinal discs to lose fluid and become thinner. Treatment is guided by an orthopedist and may include medication, physical therapy, and, in some cases, surgery.
Symptoms of spondylolisthesis
The main symptoms of spondylolisthesis are:
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Lower back pain that may spread to the buttocks or legs;
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Neck pain that may spread to the arms;
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Difficulty walking or standing for long periods;
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Numbness or weakness in the feet;
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A tingling sensation in the arms or legs.
Back or muscle stiffness, trouble coordinating movements or moving normally, and spasms in the muscles at the back of the thigh may also occur.
Spondylolisthesis may not cause any symptoms. However, symptoms can develop when the vertebral change is severe, and they vary depending on the part of the spine affected.
It is important to see an orthopedist if symptoms of spondylolisthesis appear, so the condition can be diagnosed and the most appropriate treatment can be started.
When is spondylolisthesis severe?
Spondylolisthesis is severe when it compresses nerves in the spine and causes cauda equina syndrome.
This syndrome is marked by changes in bladder, bowel, sexual organ, and lower limb function. According to the American Academy of Orthopaedic Surgeons, cauda equina syndrome occurs when nerve roots in the lumbar spine are compressed, and the nerve roots that control bladder and bowel function are especially vulnerable to damage. In these cases, treatment should be done immediately in the hospital.
In these cases, treatment should be done immediately in the hospital. It usually involves surgery because this is considered a medical emergency.
Confirming a diagnosis
Spondylolisthesis is diagnosed by an orthopedist through an evaluation of symptoms, health history, lifestyle habits, such as physical activity, and a physical exam.
During the physical exam, the doctor checks movement, muscle strength, and whether there is any difficulty walking or lifting the legs, for example.
The doctor may also order imaging tests to check the position of the spinal vertebrae and confirm the diagnosis. These tests may include X-rays, computed tomography, magnetic resonance imaging, or PET-CT.
Possible causes
The main causes of spondylolisthesis are:
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Degeneration of the vertebrae due to the body’s natural aging process;
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Congenital spinal malformations;
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Blows or trauma to the spine;
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Osteoporosis or cancer in the spine;
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A complication after spine surgery;
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Sports that place stress or overload on the spine, such as artistic gymnastics, soccer, or weightlifting, for example.
Another condition that can cause spondylolisthesis is spondylolysis. This is a fracture or crack in a spinal vertebra that can cause the vertebra to slip forward or backward.
Treatment options
The main treatments for spondylolisthesis include:
1. Rest
For people who exercise regularly, the orthopedist may recommend rest and avoiding physical activity to prevent overloading the spine and worsening symptoms.
2. Medication use
The main medications that may be recommended are:
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Anti-inflammatory drugs, such as ibuprofen or naproxen;
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Pain relievers, such as acetaminophen;
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Opioids, such as tramadol.
Other medications may also be recommended for spondylolisthesis, such as corticosteroid injections applied directly to the area of the displaced vertebra to help relieve pain and inflammation quickly.
The medications recommended by the orthopedist for spondylolisthesis are used to reduce pain and discomfort in the spine.
3. Physical therapy
Physical therapy sessions for spondylolisthesis may be recommended by the doctor to complement medication treatment. This can help relieve pain more quickly and reduce the need for higher doses of medication.
Physical therapy should be done with guidance from a physical therapist and should respect each person’s limits. Stretching exercises that increase flexibility and improve spinal stability may be recommended.
Strengthening exercises for the back and abdominal muscles may also be done because these muscles help support the spine. This can help reduce vertebral movement, decrease inflammation, and relieve pain.
Physical therapy treatment may also include pain-relief devices, manual therapy techniques, lumbar stabilization exercises, and hamstring stretches, which target the muscles at the back of the legs. Global postural reeducation, clinical Pilates, and hydrotherapy exercises may also be recommended, for example.
4. Surgery
Surgery is recommended by the doctor when no other treatment has been effective in controlling pain from spondylolisthesis.
According to the American Academy of Orthopaedic Surgeons, surgery may be recommended for degenerative spondylolisthesis when symptoms do not improve after several months of nonsurgical treatment, especially if pain or weakness affects the ability to walk, stand, or perform daily activities.
It may also be recommended when the vertebral displacement is severe and the displaced vertebra is compressing the nerves.
This surgery is performed to stabilize and align the spine, usually with a bone graft or metal rod. Physical therapy sessions are usually needed after surgery to help speed up recovery.