Spondylolisthesis
Spondylolisthesis
Spondylolisthesis is a spinal condition where one vertebra slips forward over the vertebra below it, causing misalignment of the spine. It most commonly affects the lower lumbar spine but can occur elsewhere. The slippage can compress nerves, leading to pain and neurological symptoms.
Types and Causes
- Isthmic: Caused by a defect or fracture in the pars interarticularis (a part of the vertebra). Common in athletes and younger individuals.
- Degenerative: Due to arthritis and aging-related degeneration of spinal joints and discs, leading to instability and vertebral slippage. Most common in older adults.
- Dysplastic (Congenital): Resulting from a birth defect causing abnormal facet joint formation.
- Pathologic: Due to bone weakness from diseases like tumors or infections.
- Traumatic: Caused by acute fractures of vertebral elements (pedicle, lamina, facets) from injury.
Symptoms
- Lower back pain, often worsening with standing, walking, or back movement
- Muscle tightness and stiffness, especially hamstrings
- Pain radiating to buttocks or legs (sciatica) due to nerve root compression
- Numbness, tingling, or weakness in legs
- Difficulty standing or walking
- In severe cases, bladder or bowel dysfunction
- Some individuals may be asymptomatic, with the condition found incidentally on imaging
Diagnosis
- Clinical examination assessing pain, neurological function, and mobility
- Imaging studies:
Treatment
- Conservative:
- Activity modification to avoid aggravating movements
- Pain management with NSAIDs or prescribed analgesics
- Physical therapy focusing on strengthening core and back muscles, improving flexibility
- Steroid injections to reduce nerve inflammation and pain
- Surgical:
- Considered if conservative treatment fails or neurological symptoms worsen
- Procedures include spinal fusion (stabilizing slipped vertebrae with rods and screws) and decompression surgery to relieve nerve pressure
- Recovery may take several weeks, often resulting in symptom improvement
Summary Table
| Aspect | Details |
|---|---|
| Definition | Forward slippage of one vertebra over the one below it |
| Common Locations | Lower lumbar spine (most common), cervical spine (less common) |
| Types | Isthmic, degenerative, dysplastic, pathologic, traumatic |
| Symptoms | Lower back pain, stiffness, sciatica, leg numbness/weakness, difficulty walking |
| Diagnosis | Clinical exam, X-rays, MRI, CT scan |
| Treatment | Conservative (medication, physical therapy), steroid injections, surgery if needed |
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References
- Cleveland Clinic. Spondylolisthesis: What Is It, Causes, Symptoms & Treatment.
https://my.clevelandclinic.org/health/diseases/10302-spondylolisthesis - NHS. Spondylolisthesis.
https://www.nhs.uk/conditions/spondylolisthesis/ - WebMD. Spondylolisthesis: Causes, Symptoms, Treatments.
https://www.webmd.com/back-pain/pain-management-spondylolisthesis - Hospital for Special Surgery (HSS). Spondylolisthesis: Causes, Symptoms and Treatments.
https://www.hss.edu/condition-list_spondylolisthesis.asp - Physiopedia. Spondylolisthesis.
https://www.physio-pedia.com/Spondylolisthesis
Spondylolisthesis is a common spinal disorder that can cause significant pain and neurological symptoms but is often manageable with conservative treatments. Surgery is reserved for severe or refractory cases.
