Low Back Pain: Adult Spondylolisthesis in the Low Back

In spondylolisthesis, one of the bones in your spinal column — the vertebra — slips forward and out-of-place. This could happen anywhere along the spine, but is definitely most typical in the lower back (lumbar spine). In some people, this leads to no symptoms whatsoever. Others may have back and leg pain that ranges from minimal to severe.

Kinds of Spondylolisthesis

Various types of spondylolisthesis may affect adults. The two most commonly known types are degenerative and spondylolytic. There are other more uncommon forms of spondylolisthesis, like slippage caused by a recent, severe fracture or a tumor.

Lateral  Medial Epicondylitis Tennis  Golf Elbow Leg Fracture  Low Back Pain OsteoarthritisDegenerative Spondylolisthesis

As our bodies age, general deterioration causes alterations in the spinal column. Intervertebral disks begin to dry up and weaken. They drop height, become stiff, and start to bulge. This disk degeneration is the start to both arthritis and degenerative spondylolisthesis (DS).

As arthritis builds up, it weakens the joints and ligaments that hold your vertebrae in the right position. The ligament along the back of your spinal column (ligamentum flavum) may begin to buckle. One of the vertebrae on either side of a worn, flattened disk can loosen and move forward over the vertebra below it.

This slippage can narrow the spinal canal and put stress on the spinal cord. This thinning of the spinal canal is known as spinal stenosis and is a very common problem in people with DS.

Ladies are more inclined than men to have DS, and it's more prevalent in patients who are older than fifty. A higher incidence has been noted in the Black American populace.

Spondylolytic Spondylolisthesis

One of the bones in your lower back can break and this can make a vertebra to slip forward. The break most often takes place in the area of your lumbar spine referred to as the pars interarticularis.

In most cases of spondylolytic spondylolisthesis, the pars fracture comes about during adolescence and goes unnoticed until adulthood. The typical disk degeneration that takes place in their adult years can then stress the pars fracture and make the vertebra to slide forward. This type of spondylolisthesis is most often seen in middle aged men.

Because a pars fracture causes the front (vertebra) and back (lamina) parts of the spinal bone to disconnect, only the front part slides forward. This means narrowing of the spinal canal is less likely than in other kinds of spondylolisthesis, like DS where the whole spinal bone slips forward.

Symptoms

About 4% to 6% of the U.S. populace has spondylolysis and spondylolisthesis. Most of these individuals live with the condition for quite some time without any pain or other symptoms.

Symptoms of Degenerative Spondylolisthesis

Patients with DS often go to the doctor's office once the slippage has begun to put pressure on the spinal nerves. Even though the doctor might discover arthritis in the spine, the symptoms of DS are generally the same as symptoms of spinal stenosis. For example, DS patients often develop leg and/or lumbar pain. The most typical symptoms in the legs include a feeling of vague weakness connected with prolonged standing or walking.

Leg symptoms can be coupled with numbness, tingling, or even pain that's often affected by posture. Forward bending or sitting often relieves the symptoms since it opens up space in the spinal canal. Standing or walking usually grows symptoms.

Symptoms of Spondylolytic Spondylolisthesis

Most patients with spondylolytic spondylolisthesis don't have pain and are frequently surprised to find they have the slippage when they see it in x-rays. They usually visit a doctor with low back pain related to activities. The lumbar pain is sometimes coupled with leg pain.

Doctor Examination

Doctors diagnose both DS and spondylolytic spondylolisthesis using the same examination tools.

Medical History and Physical Examination

After discussing your symptoms and medical history, your doctor will examine your back. This will include looking at your back and pushing on different areas to see if it hurts. Your doctor may have you bend forward, backward, and side-to-side to look for limitations or pain.

Imaging Tests

Other tests which may help your physician confirm your diagnosis include:

X-rays. These tests visualize bones and will show whether a lumbar vertebra has slid forward. X-rays will show aging changes, like loss of disk height or bone spurs.

X-rays taken while you lean forward and backward are known as flexion-extension images. They can show instability or too much movement in your spine.

Magnetic resonance imaging (MRI). This study can create better images of soft tissues, such as muscles, disks, nerves, and the spinal cord. It can show more detail of the slippage and whether any of the nerves are pinched.

Computed tomography (CT). These scans tend to be more detailed than x-rays and can make cross-section pictures of your spine.

Treatment

Nonsurgical Treatment

Even though nonsurgical procedures will not repair the slippage, many patients report that these techniques do help alleviate symptoms.

Physical therapy and exercise. Specific exercises can strengthen and stretch your back and ab muscles.

Medication. Analgesics and non-steroidal anti-inflammatory medicines may alleviate pain.

Steroid injections. Cortisone is a powerful anti-inflammatory. Cortisone injections around the nerves or in the "epidural space" can reduce swelling, as well as pain. It is not recommended to receive these, however, more than 3 times per year. These injections are more likely to decrease pain and numbness, but not weakness of the legs.

Surgical Treatment

Surgical candidates with DS. Surgery for degenerative spondylolisthesis is normally reserved for the patient who does not improve after a trial of nonsurgical treatment for at least three to six months.

When making a decision about surgery, your doctor will also take into account the extent of arthritis in your spinal column, and whether your spine has excessive movement.

DS patients who are candidates for surgery often are unable to walk or stand, and have a poor quality of life due to the pain and weakness.

Surgical candidates with spondylolytic spondylolisthesis. Patients with symptoms that haven't responded to nonsurgical treatment for at least 6 to12 months may be candidates for surgery.

If the slippage is getting worse or the patient has progressive neurologic symptoms, such as weakness, numbness, or falling, and/or symptoms of cauda equina syndrome, surgery may help.

Surgical procedures. Surgery for both DS and spondylolytic spondylolisthesis includes removing the pressure from the nerves and spinal fusion.

Removing the pressure involves opening up the spinal canal. This technique is known as a laminectomy.

Spinal fusion is basically a "welding" procedure. The basic idea is to fuse together the painful vertebrae so that they heal into a single, solid bone.

Surgical recovery. The fusion process takes time. It could be several months before the bone is solid, although your comfort level will often increase much faster.

If you're experiencing lower back pain and are interested in having it taken care of, Audrain Orthopaedics is the place to go for folks in Mexico, Columbia, Fulton, and Jefferson City, Missouri.

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