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Spondylolisthesis
Spondylolisthesis
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What is a Spondylolisthesis?
As you are probably aware, your spine is made up of a series of connected bones called "vertebrae." In about 5% of the adult population, a crack develops in one of the vertebrae and may later develop as a stress fracture. Due to the constant forces the low back experiences, this fracture does not usually heal like a normal bone.
This type of fracture is called a spondylolysis and may cause no problem at all unless you are a sportsperson. However, sometimes the cracked vertebra does slip forward over the vertebra below it. Once this slippage occurs, the condition is known as a spondylolisthesis and can more readily cause pain or discomfort.
This is most common leavl that a spondylolisthesis occurs is at L5/S1 (the point at which the fifth lumbar vertebra articluates with your sacrum.
What are the Symptoms of Spondylolisthesis?
Spondylolisthesis may not cause any symptoms for years (if ever) after the slippage has occurred. If you do have symptoms, they may include:
- low back pain
- buttock pain
- numbness, tingling, pain, muscle tightness or weakness in the leg (sciatica)
- increased sway back
- a limp (walking)
These symptoms are usually aggravated by standing, walking, running or sports that involve hyperextension. eg gymnastics, fast bowling (cricket) and other activities, while rest will provide temporary relief.
How is Spondylolisthesis Diagnosed?
Your physiotherapist will begin by taking a history and performing a physical examination. A palpable step or depression may be present to indicate the likelihood of a spondylolisthesis. Your physiotherapist may order X-rays of your back. However, sometimes it is difficult to see on a plain, so additional tests may be needed.
A CT scan or MRI scan can show a crack or defect in the bone more clearly. They will also show whether any of the nearby discs have suffered any wear and tear because of the spondylolisthesis.
If a spondylolisthesis is present, it is graded as I (mild), II, III or IV (severe) based on how far forward the vertebra has slipped.
Treatment for Spondylolisthesis
If your physiotherapist or doctor determines that a spondylolisthesis is causing your pain, they will usually try nonsurgical treatments at first.
These treatments may include:
- rest from aggravating activites
- anti-inflammatory medications to reduce the swelling
- analgesic drugs to control the pain
- back bracing for stabilization
- physiotherapy:
- exercises to improve your strength and flexibility so you can return to a more normal lifestyle.
- education and training in performing activities of daily living without placing added stress on your lower back.
Physiotherapy Treatment
As you begin a physiotherapy treatment regimen your physiotherapist may prescribe therapies like ultrasound, electric stimulation, hot packs, cold packs, and manual "hands on" therapy to reduce your pain and muscle spasms.
Because your muscles are the only effective way of controlling your slipping vertebrae, exercises will be aimed at the recruitment of your deep spinal stabilising muscles. You may also be prescribed gentle stretches to improve your posture and help to reduce your back pain or leg symptoms.
When you have less pain, more vigorous exercises combined with strengthening/stretching exercises will likely be used to improve flexibility, strength, endurance, and the ability to return to a more normal lifestyle. A comprehensive program may require three or more months of supervised treatment.
Developing your back and stomach muscles will help stabilize your spine and support your body. Exercise instruction should start right away and be modified as recovery progresses. Learning and continuing an exercise and stretching program are also important parts of treatment, as is maintaining a reasonable body weight.
The presence of a spondylolisthesis by itself usually does not represent a dangerous condition in the adult. Therefore, treatment is aimed at pain relief and increasing your ability to function. Although nonsurgical treatment doesn't correct the "crack" or "slippage" they usually provide long-lasting pain control without requiring more invasive treatment.
Common Treatments for Spondylolisthesis
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Surgery?
Surgery is reserved for a very small percentage of patients whose pain cannot be relieved by nonsurgical treatment methods. If a spinal nerve is being compressed by the forward slip, surgery may be needed to reopen a "tunnel," or space, for the nerve. Or, a stabilizing procedure or fusion may be recommended. This will stop any further slippage of the vertebra and also will prevent recurrent nerve pressure from developing at this site. Your options are best discussed with your Orthopaedic Surgeon.
FAQs about Spondylolisthesis
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