What is Spondylolisthesis?
Spondylolisthesis is a condition where the vertebrae slip forward or backward and distort the spinal canal. The slippage is due to fractures and/or degeneration of the bones that help hold the vertebrae in place. If the slippage is great enough, nerve roots may get pinched causing pain in the legs and feet.
What are the causes?
There are two types of spondylolisthesis. Degenerative spondylolisthesis occurs when the joints in the spine weaken, allowing the vertebra to slip forward. The normal aging process and overuse can lead to weakening of the joints in the spine, causing instability. This spondylolisthesis is most common, and is mainly seen in the older patient.
Isthmic spondylolisthesis occurs when small fractures develop next to the joints in the spine, allowing for the vertebra to slip forward. These fractures can be known as “pars defects.” The fractures occur most commonly at the L5 level as loading forces are the greatest at this level. Direct trauma may cause the fractures. Activities such as gymnastics, volleyball, and weight lifting may lead to these fractures as well. This spondylolisthesis is less common, and is mainly seen in athletic pre-teen girls.
What are the symptoms?
As the slippage gets worse, nerve roots may get pinched leading to back pain shooting down to the buttocks, legs and feet. Numbness and tingling in the legs and feet may also be present. Activities that involve arching of the back may make the symptoms worse. Weakness in the legs and trouble controlling the bowels and bladder may develop if the slippage is too severe.
What treatments are available?
Treatment options may include anti-inflammatory medications, avoidance of painful activities, pain medications, physical therapy, and epidural steroid injections. If these conservative treatments do not help, or if the slippage becomes too great, surgery may be needed to decompress the spinal canal, and stabilize the spine.