Spondylolisthesis

Despite having a complicated name, spondylolisthesis is relatively easy to explain. This is when one of the vertebrae in a person’s back slips out of place. Sometimes this is extremely painful, but sometimes it is hard to tell when it has happened. There are some common symptoms or warning signs of spondylolisthesis that can also seem like symptoms of other conditions. The first thing to do to be certain about your risk of displaced vertebrae is to schedule an appointment with a doctor. They can perform an exam and identify what may be going on.

Common Symptoms 

A symptom of spondylolisthesis is persistent lower back pain. The most common area for the vertebrae to become displaced is in the lower back, and a vertebrae being displaced can make the pain much more consistent. Many other back conditions can cause back pain, but most other conditions cause pain that changes during movement or exercise level. Other symptoms are similar to sciatica, which is commonly identified by nerve pain that travels down the leg. Many people also experience muscle tightness and stiffness. This happens because of the muscles being strained when the vertebrae is dislocated. Some patients also experience difficulty using their hamstrings, pain in the buttock muscles, and trouble standing or walking. These symptoms can be with or without pain depending on the vertebrae. 

Types of Spondylolisthesis

There are 6 grades of spondylolisthesis with various degrees of displacement and varying symptoms. 

Iatrogenic

This type of spondylolisthesis develops as a result of surgery. There are certain kinds of surgery that correct spinal pain either through disc replacement, removal of parts of the spine, or fusion of the vertebrae. If a surgeon does not correctly brace the vertebrae or if the patient does something to break the connective hardware, the vertebrae can shift excessively. In some surgeries, a doctor removes the lamina, which are the parts of the vertebrae that jut out and connect them together. This can make the vertebrae shift even more possible.

Traumatic 

A very common form, this is when the vertebrae shift as a result of an accident. This is most often caused as a result of car accidents or from sports injuries. This is when the vertebrae is forcefully pushed out of place, so it is most often symptomatic. 

Degenerative 

As people age, their spines can experience some degeneration. This can include the development of osteoarthritis. Another common problem is DDD, or degenerative disc disease. These can cause spondylolisthesis as the spine is not held together as it used to be, so the vertebrae can shift. This type is usually less painful and can be asymptomatic. 

Dysplastic 

This type of spondylolisthesis is not as common, as it is caused through birth defects and is diagnosed mostly in infants. Some defects can cause weakened vertebrae or other issues in development, causing the vertebrae to slip out of place. This can be severe or not depending on how much of a defect is present. Due to the nature of this, sometimes the displacement can occur just from bending or moving the spine in some way. 

Pathologic

This can only be caused by other conditions that weaken the vertebrae, specifically the part where the vertebrae connects. Most of the time this is because of tumors, fragile bones, or even bone infections. These other conditions weaken the bone structure, which can lead to the vertebrae shifting out of place. 

Isthmic

A small portion of the vertebrae is known as the pars interarticularis. This connective portion lies between the main body of the vertebrae and the outer lamina, which is where the spinal column hooks together and cements the spine. This area can get a small fracture, which compromises the integrity of those bones connecting. This can cause the vertebrae to displace. This type of spondylolisthesis can also be asymptomatic. 

What makes spondylolisthesis worse?  

One of the main things that makes spondylolisthesis worse, without a doubt, is ignoring it. If a person is experiencing this and does not go to a doctor, it will not get better. This cannot heal on its own and must be treated as soon as possible. If left untreated, it can cause permanent nerve damage, severe pain, and possibly even complete separation between vertebrae. This can cause paralysis or more. Any patient should make an appointment to see a doctor if they are experiencing symptoms like these! Another thing that can make vertebrae displacement worse is not following doctor’s instructions. Back strain through intense exercise, overexertion, or even just lifting heavy things as instructed can affect the severity. A patient might also experience spinal infection, which can be very painful and cause other complications. 

Spondylolisthesis Treatment 

There are several ways to treat spondylolisthesis depending on the severity. 

Low severity

When the vertebrae has shifted less than 25%, it is most often treated through physical therapy. Strengthening the muscles around the area can help to hold the vertebrae in place and help the patient with nerve pain as well. This can also be treated through over the counter pain meds to help with inflammation. 

Moderate Severity 

More often than not, this level of shifting can be helped through bracing. Several different kinds of back braces exist that can help the spine alignment. Narcotics, which are high-level pain medications, can help as well. Another treatment available is steroid injections, which can treat pain for up to a year. 

High Severity

If none of the other treatments work, or if the vertebrae has shifted more than 75%, the main treatment left is surgery. There are several different surgeries available that depend on the type of spondylolisthesis the patient is experiencing. Some of the main options include fusing the vertebrae or bracing them through surgical hardware. Most of these surgeries can be done in a minimally invasive manner, which can make them low risk. This tends to be the most effective treatment, especially in more painful cases. 

Make an Appointment

If you are concerned that you may have spondylolisthesis, make an appointment today with a spine specialist! The sooner you are seen, the faster you can begin to address your pain and start healing.