What is Spondylolisthesis?
Spondylolisthesis occurs when one of your vertebrae slips forward onto the one below it. This causes a gradual deformity of the lower spine, as well as a narrowing of the spinal canal, known as spinal stenosis. Spondylolisthesis is graded from one to five depending on the degree of slippage:
• Grade I: under 25% slippage
• Grade II: 25% to 50% slippage
• Grade III: 50% to 75% slippage
• Grade IV: over 75% slippage
• Grade V: the vertebra has slipped all the way off the front of the vertebrae below it. This is a rare condition that is referred to as spondyloptosis.
What Causes Spondylolisthesis?
Spondylolisthesis is often the result of a stress fracture in the vertebra called spondylolysis. It is most commonly seen in young athletes who participate in sports that involve frequent overextension of the lumbar spinal region. These sports can include football, weight lifting, and gymnastics. Often, these fractures are undiagnosed, which means that the individual does not get the rest that is needed for the area to heal.
When spondylolysis is untreated, the weakened vertebra is prone to slippage. When this slippage occurs, lower back and leg pain is the result. Doctors believe that there is a genetic factor in the development of spondylolisthesis. Some individuals have a vertebral bone that is thinner than normal, making it more vulnerable to fractures.
Symptoms of Spondylolisthesis
The condition can easily go unnoticed because it is often symptom free. Some individuals have no obvious pain or symptoms. Their spondylolisthesis is not discovered until they have an X-ray taken for an unrelated injury or medical condition.
Among those who do experience symptoms, the most common spondylolisthesis symptom is lower back pain. Spondylolisthesis can be mistaken for an acute back injury at times; some people develop a lesion when they are younger, but do not experience symptoms until later in life. In these cases, the inciting event for pain is usually bending or twisting.
People with spondylolisthesis also often experience leg pain. This pain occurs when there is narrowing in the area where the nerves that serve the leg exit the spinal canal. Leg pain may include a tightness in the hamstrings, the muscles that run along the backs of the thighs. In some cases, individuals will have difficulty standing or walking.
Additionally, individuals who have a high degree of slippage may experience weakness, numbness, or tingling in one or both of their legs. This is due to nerve compression.
X-rays are the best method for diagnosing spondylolisthesis. This is because physical exams will not reveal much visible deformity. Additionally, the symptoms can often be vague and easily associated with a number of other back problems. In some cases, CT scans or bone scans are needed to confirm a diagnosis.
The initial treatment for spondylolisthesis is rest, which is followed by abdominal and trunk strengthening exercises. Our physical therapists can guide you through these exercises to ensure that you are able to do them without making painful symptoms worse. Those with significant back or leg pain will find anti-inflammatory medication or corticosteroid shots helpful for relieving swelling and pain. Braces can sometimes provide pain relief by stabilizing the area.