What Is Spondylolisthesis?
Spondylolisthesis refers to the abnormal displacement of the vertebra on top of the one below it. Spondylolisthesis meaning has been derived from the Greek words “spondylo” meaning vertebra and “listhesis” meaning slip. So listhesis meaning is slip only. The condition frequently occurs in the lower back, where the fifth lumbar vertebra slipping from its usual position above the sacrum is referred to as lumbar spondylolisthesis L5 S1 or spondylolisthesis L4-L5. The dislocated bone may compress the nerves resulting in lower back pain, stiffness and even leg problems, though not everyone will experience any symptoms and they may simply be diagnosed when they happen to have an x-ray taken. The severity of the problem will depend on the extent of the displacement.
Types of Slippages
The slippage occurs due to the direction of movement of the vertebra.
Anterolisthesis
The term anterolisthesis means forward slipping, and refers to the superior vertebra moving in front of the inferior vertebra. Anterolisthesis is more common, and anterolisthesis L5 on S1 is one of the most commonly diagnosed conditions of the lumbar spine.
Retrolisthesis
Retrolisthesis is when there is a back-sliding, meaning that the upper vertebra slides posteriorly over the lower vertebra. This condition is relatively rare, is usually associated with intervertebral disk degeneration, and can be painful during upright posture.
Spondylolisthesis Grades Explained
Spondylolisthesis is graded based on the percentage slip of the upper vertebral bone over the lower one when viewing it sideways via an X-ray image. The spondylolisthesis grades range from 1 to 4, with the grade determining the form of treatment; however, just like the grade, symptoms are equally important in spondylolisthesis.
Grade | Slippage | What it usually means |
Grade 1 | Up to 25 % | Mild, surgical treatment is not required |
Grade 2 | 25 to 50 % | Moderate, treated based on symptoms |
Grade 3 | 50 to 75 % | Severe, surgery is generally recommended |
Grade 4 | 75 to 100 % | Extremely severe, surgical treatment is required |
A better grade does not necessarily mean less pain; therefore, your physician will take your grade into account along with your symptoms and nerve results.
Spondylolysis vs Spondylolisthesis vs Spondylosis
Though the above three conditions may seem similar to one another, yet each of them represents a different problem. Spondylolysis is characterized by a small crack in the pars interarticularis of the vertebra, which is common among young athletes who constantly bend backwards. Spondylolisthesis refers to the movement of a vertebra and may occur after spondylolysis as the weakened vertebra cannot withstand its position anymore. Spondylosis involves the aging of the discs and the joints, without the need for a bone fracture or a slipped joint. One may be affected by several conditions, for instance, having lumbar spondylosis at the same time as a slipped vertebra.
Spondylolisthesis Symptoms
The spondylolisthesis symptoms range from one patient to another. Some people experience no symptoms while others will have lower back pains which become worse when standing, walking, and arching backward but relieved by sitting. Tight muscles of the hamstrings, stiffness and instability of the spine are other symptoms experienced. If the vertebra compresses the nerves, then the pain can go down to the buttock or legs and cause numbness or weakness as seen in sciatica pain. Extreme cases of slippage may cause postural changes. The lack of control over bowel or bladder movements is a medical emergency.
Understanding Your Report
The spondylolisthesis X ray is performed in a side view standing position, and it illustrates the slippage of the vertebra, while the bending position can detect motion missed in a supine position. A radiology report may state that there is “anterolisthesis of L5 on S1” or that L5 has shifted forward over S1 and this is usually graded as well as a measurement in millimeters. The MRI scan gives more information on the nerves and also notes any spinal canal narrowing or foraminal stenosis. However, the radiology report only describes the anatomy and does not describe the symptoms.
What Causes Spondylolisthesis?
Spondylolisthesis has a number of possible causes. Vertebral displacement can happen because of the displacement of vertebrae as a result of a fracture of the pars interarticularis (spondylolysis). The degenerative spondylolisthesis arises as a result of the wear and tear process of the discs and the facet joints. This leads to the loosening of the vertebra. Some people can be born with weak bones that make them susceptible to the displacement of vertebra. The disorder is more common among women over fifty and athletes practicing back extension exercises.
Spondylolisthesis Treatment Options
The spondylolisthesis treatment will depend on the grade of severity, symptoms, and involvement of nerves, and almost everyone begins without any surgery.
Non-Surgical Treatment
For low-grade cases, a resolution is achieved through the use of pain and anti-inflammatory drugs, physiotherapy for strengthening of the core muscles and spinal stabilization, avoiding activities that include lifting and bending of the back, and epidural or nerve root injections when there is pain in the legs.
Surgical Treatment
The decision to perform surgery is made for high grade, persistent symptoms related to the nerve involvement, weakness, or pain that is not responding to conservative care. The primary purpose is the decompression of nerves and stabilisation of the slipping segment by spinal fusion. A minimally invasive surgical technique called MIS TLIF can be performed using small cuts. Dr. Zahir Abbas Merchant, an experienced orthopaedic surgeon for more than 15 years, makes a treatment plan based on the scan and symptoms individually.
When to See a Spine Doctor
If the back pain lasts beyond several weeks or is accompanied by leg pain, numbness, or weakness, it is advised that you consult a spine specialist. If there is any weakness or difficulty in urination or defecation, it is recommended that you see a doctor immediately. The spine specialists from The Spine eXpert in Mumbai will help you read your X-ray/MRI.