Spondylolisthesis

Spondylolisthesis is a spine-related condition that develops when a vertebra slides forward over the one beneath it. While most cases occur in the lower back, some patients experience it in their neck or mid-back region.

This article covers everything about spondylolisthesis—from its types and symptoms to causes and treatments. Readers will also learn the right time to consult a doctor and ways to handle this condition.

What is Spondylolisthesis?

Spondylolisthesis comes from Greek words meaning "vertebra" and "to slip." This condition arises when one vertebra slips forward (anterolisthesis) or backward (retrolisthesis) over the next vertebra. Spondylolisthesis usually develops in the lower back (lumbar spine), especially at the L5-S1 level, though it can sometimes affect the cervical spine. 

Types of Spondylolisthesis

Doctors group spondylolisthesis into six main types based on what causes them:

• Degenerative Spondylolisthesis: Adults over 50 commonly get this type from normal wear and tear of discs and joints
• Isthmic Spondylolisthesis: A stress fracture in the pars interarticularis causes this, and it's common in young athletes
• Dysplastic/Congenital Spondylolisthesis: People are born with this due to vertebrae that didn't form right
• Traumatic Spondylolisthesis: This happens after serious injuries from accidents or falls
• Pathologic Spondylolisthesis: Diseases like tumours, infections, or osteoporosis lead to this type
• Iatrogenic Spondylolisthesis: This shows up after complications from spine surgery

Symptoms of Spondylolisthesis

Some people with spondylolisthesis don't feel any symptoms. But those who do might experience the following spondylolisthesis symptoms:

• Back pain that gets worse while standing or walking
• Pain that spreads to buttocks and thighs
• Tight hamstring muscles
• Legs feeling numb, tingly or weak
• Problems bending forward
• Back stiffness

Spondylolisthesis Causes 

Several things can make vertebrae slip. The spine naturally weakens with age, and repeated activities that stretch the spine too far can create stress fractures. Genes play a part since this condition sometimes runs in families. Athletes who do gymnastics, football, weightlifting, and track put a lot of strain on their lower backs, which increases their risk. People born with spine alignment problems might also be more likely to get this condition.

Risks of Spondylolisthesis

Some people have a higher chance of getting spondylolisthesis. 

• Women get degenerative spondylolisthesis about three times more often than men. 
• Black women's risk is three times higher than white women's. 
• More than the optimal body weight puts more pressure on the spine. 
• Young people who do activities that stretch their lower spine too much face a higher risk.

Complications of Spondylolisthesis

Spondylolisthesis can cause serious problems if left untreated. 

• Nerve roots often get pinched where the slippage occurs. 
• Spinal stenosis (a narrow spinal canal)
• Cauda equina syndrome (affecting how you control your bladder/bowels)
• Long-term back pain

Diagnosis

Doctors use physical examinations and imaging tests to diagnose spondylolisthesis. The examination usually involves patients lying down to raise one leg straight up. This movement often causes pain in patients who have tight hamstrings or sciatica from spondylolisthesis. X-rays serve as the starting point to show if a vertebra has moved forward.

Doctors might need additional tests to get a complete picture:

• MRI scans - best option to evaluate soft tissues and nerve compression
• CT scans - show detailed bone structure and fractures clearly
• Bone scans - help track active fracture healing

Treatments for Spondylolisthesis

• Noninvasive treatment: Non-surgical spondylolisthesis treatment works well for most patients. The standard approach starts with:
  • Rest and changing activity levels
  • Anti-inflammatory medications such as ibuprofen
  • Physical therapy that builds core strength and stretches hamstrings
  • Epidural steroid injections to reduce pain
  • Bracing that keeps the spine stable
• Spondylolisthesis surgery: Surgical options come into play if conservative treatments don't work after 3-6 months or neurological symptoms get worse. These procedures include spinal decompression (laminectomy) to free trapped nerves and spinal fusion to stabilise affected vertebrae.

When to See a Doctor

Back pain that lasts more than 3-4 weeks needs medical attention, especially if the pain spreads to your thighs or buttocks. Don't wait to get emergency care if you experience groin numbness, lose bladder or bowel control, or have trouble walking. These symptoms might point to cauda equina syndrome, a serious condition that needs immediate treatment.

Prevention

You can't completely prevent spondylolisthesis, but these strategies help reduce your risk:

• Keep your weight in check to ease spine pressure
• Build strong core muscles through regular exercise
• Use good posture throughout the day
• Pick low-impact activities like swimming or cycling
• Get enough calcium and vitamin D to keep bones healthy

Spondylolisthesis vs Spondylosis 

Dr. Priyesh Dhoke

MBBS, MS (Orthopedics) F.A.O.S. (Australia) AO Spine International Clinical Fellowship, Brisbane (Australia) Clinical fellowship in Minimal invasive Spine Surgery (MISS) (SGH, Singapore)
Ganga CARE Hospital Limited, Nagpur

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