Spondylolisthesis is a condition in which one of the vertebrae in the spine slips out of place, shifting over the bone below. In most cases, this condition affects the lumbar or lower spine.
Patients with spondylolisthesis do not always have symptoms. But because the joints and nerves can be pinched when a vertebra is not in the proper position, some patients suffer low back pain, muscle tightness or weakness, sciatic leg pain and numbness or tingling in the thighs and buttocks.
Over time, lordosis (swayback) or kyphosis (roundback) can develop as a result.
Causes of Spondylolisthesis
Genetics may play a part in some cases of spondylolisthesis, as children may be born with thin vertebral bone or defective joints. Consequently, these individuals are more susceptible to bone slippage over the course of their lifetimes. When this condition occurs in children, it may be related to a birth defect in that portion of the spine.
Spondylolisthesis in adults is typically the result of aging or abnormal wear and tear on the bones and cartilage, such as from arthritis. Bone problems, such as osteoporosis or low bone density, also may be contributing factors.
Sudden injury or trauma to the spine also can cause spondylolisthesis.
More often, however, stress fractures caused by repeated use over time are responsible. Participating in sports activities that stress the spine, including gymnastics, football and weight lifting, can increase the risk of suffering spondylolisthesis, or cause the condition to worsen.
A medical history and physical exam are the first steps to diagnosing spondylolisthesis. The Sports and Spine specialist will observe the patient’s posture and range of motion, and test reflexes and muscle strength.
The doctor also will order X-rays to determine if a vertebra has slipped.
To see how the bone moves, it may be necessary to take X-rays of the patient while he or she is bending forward and backward. To confirm a spondylolisthesis diagnosis, a CT scan or MRI also may be ordered.
Treatments for Spondylolisthesis
Treatment for spondylolisthesis depends upon the severity of the vertebra slippage, but many patients are able to find symptomatic relief through conservative measures.
Physical therapy exercises may be recommended to stretch and strengthen the muscles of the lower back. In some spondylolisthesis cases, the Sports and Spine specialist may also recommend avoiding contact sports for a period of time, or wearing a back brace to limit spine movement.
For pain relief, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are often recommended. For persistent or severe pain, epidural steroid injections may be considered.
If conservative treatments are unsuccessful at reducing the symptoms of spondylolisthesis, or if the vertebra slippage progressively worsens, surgery may be needed. A procedure may be performed to relieve pressure on the nerves. Or if no other treatment can provide relief from spondylolisthesis, the orthopedic surgeon may perform a spinal fusion to maintain the vertebrae in the proper position.