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Spondylolisthesis

Spondylolisthesis most commonly affects the lower back or the lumbar Spine. It's a condition where one vertebra slips over the other which leads to pinching of the spinal nerves causing numbness or pain in the back or legs. It’s quite a painful condition but treatable in many cases. Both nonsurgical and surgical methods may be used. Proper exercise methods and techniques can help in avoiding this condition

Types of spondylolisthesis:

The types of spondylolisthesis are categorised under 3 parts :

  • Congenital spondylolisthesis : A condition in which the patient is born with the abnormality of the posterior bony arch of the spine, which causes the slippage leading to fracture. It is commonly associated with abnormality of the facet joints.
  • Isthmic/ Lytic spondylolisthesis : Isthmic spondylolisthesis is a condition where there is a defect in a part of the vertebra called the pars interarticularis. This bone connects the upper joint of one vertebra to the lower joint of the vertebrae. The fracture is an outcome of the stress fracture in individuals with a genetic predisposition i.e some minor abnormality or weakness from the time of the birth most often causes this. Sometimes the defect may exist without any forward slip, This condition can be painful.
  • Degenerative spondylolisthesis : Degenerative spondylolisthesis is a condition caused due to forward slippage secondary to arthritis of the spine. This process is usually also linked with Spinal stenosis. It is mostly caused due to long-standing degenerative disc disease, leading to weak facet joints in the back of the spine.

What are the symptoms of spondylolisthesis?

The symptoms of spondylolisthesis vary depending upon the case and its type. People suffering from mild spondylolisthesis cases may not face any symptoms. Patients suffering from moderate to severe spondylolisthesis pain complain of pain in legs while standing or walking. Some of the common symptoms include :

  • Persistent pain in the lower back
  • Stiffness in your back and legs
  • Lower back tenderness
  • Thigh pain
  • Tight buttock muscles and hamstrings

What are the causes of spondylolisthesis?

Causes of spondylolisthesis vary depending on age, genetics, and lifestyle of the patient. Children can suffer from spondylolisthesis as the result of a birth defect or an injury. However, people of all ages are prone to get spondylolisthesis. it may be genetic in nature i.e the condition runs in the family. Fast growth during adolescence may also be a contributing factor to spondylolisthesis.

Playing sports which may cause strain due to overstretching or any sort put of excessive stress on your lower back can lead to spondylolisthesis. Most common sports associated with Spondylisthesis are

1.Football

2.Gymnastics

  • Track and field
  • Weightlifting
  • Basketball
  • Ballet
  • Dancing
  • Fast pace bowling

How To Diagnose spondylolisthesis ?

Physical examination : Patients suffering from spondylolisthesis may complain of pain when firm pressure is applied over the low back. At times a step may be felt due to forward slipping of one vertebra over the other. Patients may exhibit pain or weakness in parts of their lower extremities.

X-ray : X rays help in diagnosing spondylolisthesis and also grading its severity. Special X-ray called Dynamic views help in diagnosing the abnormal mobility of the spondylolisthesis segment. Whole Spine X rays help to understand the global spinal alignment which is vital in deciding the exact treatment of spondylolisthesis.

CT Scan : In a lot of cases, CT Scan will be recommended in order to get more details especially to understand the bony anatomy of the spondylolisthesis segment.

MRI : MRI helps to understand the amount of nerve compression due to spondylisthesis. It also gives an opportunity to study neural anatomy in the non listhetic spinal segments.

Bone Scan : In Doubtful cases, bone scan can help to diagnose occult spondylolysis and stress fractures of the pars interarticularis

What are the treatment options for spondylolisthesis ?

The treatment options for spondylolisthesis depends on your severity of the condition in consideration of pain and degree of slippage of vertebrae. A lot of patients may respond well to non operative treatments which consist of a structured physiotherapy and medication program. The non operative measures do not necessarily put the vertebra back in place or reduce the spondylolisthesis. But these measures can provide good relief from pain and symptoms of listhesis. During the non surgical treatment it is recommended to avoid contact sports activity during the healing process.

Common nonsurgical treatment methods include:

  • Wearing back braces
  • Physiotherapy
  • Anti-Inflammatory drugs as prescribed by the doctor to reduce pain
  • Epidural steroid injections: This helps in reducing the severity of back and leg pain.

In severe spondylolisthesis or patients not responding to non operative treatment, surgery can be an excellent treatment method.

Surgical Method: Aim of surgery is to safely restore the spinal alignment and stability, decompress the spinal nerves and make an environment to promote spinal fusion.

Various surgeries described for this condition are

  • Transforaminal Lumbar interbody fusion
  • Minimally invasive Transforaminal lumbar interbody fusion (MIS TLIF)]
  • Anterior Lumbar Interbody fusion
  • Oblique lumbar Interbody Fusion

Depending on individual condition and expectations, doctors at Pune Spine Institute will suggest the best treatment modality for your spondylolisthesis.

Recovery for most patients is very rapid. After surgery, patients are made to stand and walk on the same or the next day. Patients can expect to go home 3-4 days after the surgery. Depending on the nature of work, they can rejoin their work by 3-6 weeks and can participate in recreational sports by 3- 6 months. Post spinal fusion surgery, it takes approximately four to eight months for the bones to fully fuse together after which there is absoliutely no restriction of activities. The success rate of the surgery for spondylolisthesis is very high and patients are very happy after the surgery.