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Spondylolisthesis
Overview/Definition
Symptoms
Potential Causes
Diagnosis
Treatment Options
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Overview/Definition
Spondylolisthesis occurs when one vertebra slips forward in relation to an
adjacent vertebra, usually in the lumbar spine.
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Symptoms
Spondylolisthesis, one of the most common causes of persistent back pain
in children and adolescents, may or may not cause back pain. If pain is present,
it may result from “mechanical” problems (certain activities,
movements, or positions that cause pain). Pain may also arise from within
the moving parts of the spine. If compression of the spine pinches or irritates
nerves, that can also cause pain. For example, a pinched nerve can produce
pain in the back, sciatica, or pain that radiates down to the foot. It can
also cause numbness in the foot and weakness in the muscles supplied by the
affected nerve.
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Potential
Causes
Spondylolisthesis can be caused by degeneration, trauma or congenital defects.
It most commonly occurs in the lowest lumbar vertebra on the bony ring formed
by the pedicle and lamina bones, which protects the spinal cord and spinal
nerves. The bone is weakest in an area called the “pars interarticularis,” which
joins the upper and lower joints. This pars defect or fracture is called
spondylolysis and is believed to be a stress fracture that results from repeated
strain on a bone. At first, the body can heal the damage produced by strain
on the bone. However, if repeated strains occur faster than the body can
respond, the bone will eventually fracture. If the pars is fractured, the
condition is called spondylolysis.
Spondylolisthesis occurs if a vertebra shifts as a result of a widening fracture
when the muscles and ligaments holding a vertebra in place become overworked;
the vertebral body can then slide forward onto the vertebra below. The forward
slip makes the spinal canal smaller, leaving less room for the nerve roots
and often causing a pinched nerve.
Teenagers sometimes develop a unique type of spondylolisthesis in which one
vertebra slips forward and slides completely off the vertebra below. Spondylolisthesis
can also occur in the cervical spine and may result from a neck injury or
rheumatoid arthritis. Cervical spondylolisthesis usually causes neck pain
and stiffness.
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Diagnosis
Your physician will take a history, perform a physical exam, and will likely
request an X-ray. X-rays are often all that are needed to diagnose a pars
defect or forward slip of a vertebra. Sometimes however, bone
scans and CT
scans are preferred.
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Treatment
Options
Conservative Treatment
Treatment for spondylolisthesis is similar to treatment for other causes
of mechanical and compressive back pain. Doctors may prescribe rest during
the acute phase, including avoidance of sports, to help relieve symptoms.
Special braces, casts, or corsets may be used to help heal a stress fracture
and to ease pain. Your doctor may also encourage you to work with a physical
therapist and/or prescribe pain medication. Specific exercises are important
for rehabilitation and return to sport.
Surgical Treatment
If conservative treatments fail to manage your pain, your doctor may recommend
surgery. Surgical treatment should relieve both mechanical and compressive
pain as well as any pressure on spinal nerves. The surgical procedure for
spondylolisthesis is known as decompressive laminectomy of the lumbar spine,
and will free up or "decompress" the affected nerves. The surgeon
will remove a section of bone from the back of the spine (lamina) and/or
a portion of the facet joints. Because the lamina and facet joints provide
stability to the spine, removing them can cause the spine to become loose
and unstable. When this occurs, doctors will include spinal
fusion as part
of the procedure.
Spondylolysis and Spondylolisthesis are unstable conditions. Fusion is almost
always a part of the surgical plan. Sometimes decompression is also necessary.
In adolescents and children with spondylolysis only and no spondylolisthesis,
direct repair of the pars defect without fusion may be appropriate.
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