Non-Surgical Spondylolisthesis Treatment

• Medications – Acetaminophen can be prescribed for pain. NSAIDS’s and/or oral steroids can be prescribed to reduce inflammation.
• Heat and/or Ice – Heat or ice helps to reduce localized pain. Ice is recommended to relieve pain or discomfort right after an activity. Heat is recommended to relax your muscles, which can help to promote blood flow and healing.
• Physical Therapy – Stretching is the best form of physical therapy. Stretching your hamstrings twice a day can alleviate stress on your lower back. Make sure each movement you make is controlled, but gradually increases.
• Manual Manipulation – Chiropractic manipulation can possibly help to reduce pain by mobilizing joint dysfunction. It is extremely important that you contact a trained health professional.

Spondylolisthesis Treatment – Prevention

The best way to prevent spondylolisthesis is to take the steps necessary to prevent vertebra slippage. There are a number of steps you can take now to help reduce your risks later.

Diet

• Calcium is needed to build strong bones. Fortified milk has vitamin D that is needed for proper calcium absorption. Drink low-fat and skim milk and eat nonfat yogurt and reduced-fat cheeses for good sources for calcium.
• Soy contains calcium, as well as plant estrogens. It helps to maintain bone density. Try soy cereals and soy cheeses. Consider making a smoothie with soy milk.
• Limit your intake of protein because too much can raise your excretion of calcium. Women should not have more than 50 grams per day and men not more than 63 grams.
• Onions have been known to reduce bone breakdown.

Exercise

Exercise is an effective preventative spondylolisthesis treatment. A weight bearing exercise program can help to stop further bone loss and can help you build bone as you age. It can also improve your posture, balance, and flexibility. Try exercising at minimum 30 minutes three times a week. Walking, running, low-impact weight lifting, stair climbing, volleyball, and tennis are great ways to get in some exercise.

While swimming is a great exercise, you must incorporate this into one of the other exercises mentioned above. Swimming will not allow your bones and muscles to work against gravity, which will not help in bone-building.

Be careful when lifting weights that you do not overexert yourself. This could end up leading to isthmic spondylolisthesis. If you are interested in sports, such as gymnastics, football, or pole vaulting, you will want to take steps to prevent hyperextension. Shorter practices will go a long way in helping to prevent spinal injury. A trained coach will understand this. Parents should get involved and make sure the coaches are acting in the best interest of their child.

If you have lordosis, avoid hyperextension sports. Lordosis is an exaggerated inward curvature just above the buttocks. It is caused by weak and stretched muscles around the hip and spine. This causes an imbalance. Lordosis increases your chances of experiencing spondylolisthesis.

Supplements

Calcium is a great supplement to include in your daily routine as a preventative spondylolisthesis treatment. Men and women need 1,000 mg of calcium a day during midlife. This will increase to 1,500 to 2,000 mg for women during menopause and men after age 65.

These supplements should be taken throughout the day and not in just one lump dose. This is because your body can only absorb a limited amount of calcium at one time. Always take with meals. Choose a supplement that contains vitamin D to help with the absorption.

Lifestyle

• Stop smoking. Smokers tend to have a lower bone-mineral density. This can lead to a higher risk for falls causing spinal fractures and hip fractures. Fractures heal slower in people who smoke and are more likely to heal improperly.
• Don’t drink too much alcohol. Alcohol prevents your body from absorbing calcium properly.
• Depression can cause your body to produce cortisol. This can take minerals from your bones. Don’t let your depression get out of hand. Talk to a doctor as soon as possible to see if there is something that can be done to help you.

Spondylolisthesis Treatment – Surgery

In the majority of cases, non-surgical spondylolisthesis treatment is sufficient. However, if all angles have been exhausted, there is the option of spinal fusion surgery. Spinal fusion surgery is effective; however, it does require a long recovery period.

You do not have to live with the pain. Contact your doctor for further details on the different steps that can be taken for spondylolisthesis treatment.

Spondylolisthesis Symptoms Based on Grade

The slippage of the vertebra over the disc below is measured by a grade scale. This scale measures in grades from one to five. One is the least amount of slippage, while five is the greatest amount. The higher the grade level diagnosed, the more severe the symptoms will likely be.

For example, if you are diagnosed with a grade 1 slippage, then you may not even experience any discomfort. If you are diagnosed with a grade 2 or 3 slippage, you may experience minor discomfort. However, if you are diagnosed with a grade 4 or 5, you are more likely to be experiencing extreme and debilitating pain.

Common Spondylolisthesis Symptoms

Lower back pain is the most common symptom of spondylolisthesis. This pain is generally aggravated by activities that will put stress on your lower back or by activities that cause your back to hyperextend or bend backwards.

You could also experience the following common spondylolisthesis symptoms:

• Muscle tightness (especially the hamstring muscle)
• Discomfort or pain in the buttocks and thighs
• Stiffness
• Tenderness where the disc has slipped
• Muscle spasms

Another common symptom that spondylolisthesis can cause is lordosis. This is an extreme inward curvature of a portion of the lumbar and cervical spine. Both the cervical and lumbar sections are normally curved to some extent; however, spondylolisthesis will cause an excessive curvature. If lordosis occurs, then you may also experience a protruding abdomen. It is also possible to experience kyphosis, which is a round back as the upper spines falls off the lower spine.

Nerve Damage Spondylolisthesis Symptoms

Nerve symptoms can result when the nerves that exit the spinal cord or the spinal cord itself becomes pinched by the slipped vertebra. The following symptoms can occur when the nerves are involved:

• Pain in the leg
• Electric shock-type symptoms shooting down the leg
• Legs and feet are numb or tingle
• Weakness in the muscles of the leg

Severe Spondylolisthesis Symptoms

If you experience problems with bowel or bladder function or any numbness around your genitals, you should contact your doctor immediately. These issues could be related to cauda equina syndrome.

Bladder problems can include:

• Urinary retention (inability to urinate)
• Urinary hesitancy (difficulty initiating urination)
• Decreased urethral sensation (decreased sensation when urinating)
• Incontinence (inability to stop or control urination)

Bowel problems can include:

• Incontinence (unable to stop or feel a bowel movement)
• Constipation
• Loss of anal sensation

Body Mobility Spondylolisthesis Symptoms

A more advanced stage of this spinal condition can affect your body’s mobility. It can result in causing you to walk in shorter strides with your knees slightly bent, also known as “waddling”. When you start to waddle rather than walk, you are rotating your pelvis more because of the decreased mobility in your hamstrings.

A general stiffening of your back and tightening of the hamstrings can result in a change to your posture. The changes in the discs of the spinal column can cause you to lean forward slightly resulting in a slump. If you are experiencing any spondylolisthesis symptoms, contact your doctor for the different treatment options available.

Factors for Spondylolisthesis Surgery

• Age
• Grade (level) of spondylolisthesis
• Overall health
• Neurological deficit (weakness or numbness and/or bowel or bladder dysfunction)
• Spinal curvature or deformity
• Nerve root entrapment or compression radicular pain
• Risk factors for failure of bones to fuse (pseudarthrosis)

Benefits/Risks for Spondylolisthesis Surgery

Spondylolisthesis surgery is used as a last resort due to the risks involved; however, the benefits could help a person diagnosed with severe spondylolisthesis. A successful surgical procedure will relieve pressure or compression of the affected nerves, help to prevent further slippage and continued nerve compression by stabilizing the vertebra with fusion, and restore spinal alignment.

The potential risks and complications involved are why surgery is done as a last resort. Listed below are just a few to consider:

• Hardware failure
• Pain continues even after surgery
• Adjacent segment degeneration
• Infection
• Bleeding
• Dural leak
• Nerve root damage
• Non-fusion
• General anesthetic risks (blood clots, pulmonary emboli, pneumonia, heart attack, and/or stroke)

While most of these risks and complications are rare, they are a possibility. Overall general health and lifestyle choices can increase these risks. These include but are not limited to:

• Smoking
• Obesity
• Multilevel fusions
• Osteoporosis
• Diabetes
• Rheumatoid arthritis
• Prior failed back surgery

Types of Spondylolisthesis Surgery

The type of surgery for spondylolisthesis you have will depend on your symptoms and your doctor. There is some indecision among surgeons as to which type is best; however, it is important as a patient to understand all of the options that are available to you.

There is a minimally invasive surgery that should be considered before all other options. Talk with your surgeon before accepting a more invasive procedure to find out why the minimally invasive procedure will not work for you. It is possible that the minimally invasive procedure is not an option in your case; however, you will want to ensure this decision by getting a second or even third opinion.

Surgical Procedures

While there are invasive and minimally invasive surgeries, there are three surgical procedures that are based on the approach to the vertebral fusion. All three approaches can be used for invasive and minimally invasive surgeries. These approaches are:

• ALIF – Anterior (front) Lumbar Interbody Fusion
• PLIF – Posterior (back) Lumbar Interbody Fusion
• TLIF – Transforaminal (side) Lumbar Interbody Fusion

Open Back Surgery

If your surgeon feels it is necessary, it is possible to realign your spine. However, most will first try to take the pressure off the nerves to stabilize the spine. There are two main types of open back surgery. These are:

• Decompression Procedure
• Spinal Fusion

Decompression procedures, such as a laminectomy or laminotomy, are used to remove whatever spinal component is placing the pressure on your nerve root and spinal cord. This will then release the pressure on the nerves, which results in eliminating the source of pain.

A spinal fusion is often performed in conjunction with a decompression procedure. This happens because decompression involves removing the spinal components causing the pressure, which then creates an unstable spinal structure.

A spinal fusion will then be performed to insert a bone graft or some type of synthetic material into the area of your spine where the component was removed. Screws and rods are used to support the spine as it heals, which forces two or more vertebrae to permanently be fused together as one bone.

Minimally Invasive Surgery

This procedure is done through several tiny incisions instead of one big incision. Surgeons use microscopes and very small instruments for decompression and fusion. The minimally invasive surgery allows for less blood loss during surgery. Recovery time is much less because your surgeon will not have to cut as much into your muscles, ligaments, and tendons.

Sometimes surgeons will use techniques from the open back and the minimally invasive procedures together called a “mini-open” procedure. Pain does not have to be a constant in your life. If you have tried all the non-surgical treatments and still are in severe pain, spondylolisthesis surgery could be the answer for you.

Basic Spondylolisthesis Definition

The medical definition of spondylolisthesis can be explained by looking at the word itself. Dividing up the word into two parts is a simple way to remember the basic spondylolisthesis definition.

Spondylo is the first part and means spine. Listhesis is the second part, which means slippage. When you put these two parts together, the basic spondylolisthesis definition is a forward slippage or displacement of a vertebra over the lower segment. It is generally the fourth or fifth lumbar section of your spine.

This medical issue can be developmental or acquired. Developmental spondylolisthesis can exist at birth or could develop during childhood. While it may exist at this time, it is not usually noticed until later on in life. Acquired spondylolisthesis can be the result of daily stresses on your spine or from a single/repeated force of impact to your spine.

Spondylolisthesis Definition of Different Types

There are six different types of this condition. Listed below are brief descriptions of each type. This should only be used as a guide for your own informational purposes.

• Dysplastic or Congenital – This is caused by an abnormality of the joints of the spine. It is commonly present in childhood and occurs in the lowest joint of the spine.
• Isthmic – This is caused by a fracture through the pars interarticularis (a portion of the vertebra) that allows for slippage. This is also commonly present in childhood and occurs in the L5 to S1 level, which is the lowest joint of the spine.
• Degenerative – This commonly occurs at the L4-5 level and is generally caused by degenerative disc disease and arthritis of the joints. This is also commonly accompanied by spinal stenosis (narrowing of the spinal canal).
• Traumatic – This is usually caused from a fracture of the portion of the vertebra, except the pars interarticularis.
• Pathologic – This is generally the result of a tumor or infection that erodes in the spine causing slippage.
• Iatrogenic – This usually occurs in patients who have had extensive spinal surgery, such as a laminectomy or decompression surgery.

If you are experiencing pain or discomfort, it is important that you make an appointment with your medical physician to confirm the cause.

Spondylolisthesis Definition Based on Severity

This medical issue can also be defined by its severity. It is graded based on the amount that one vertebral body has slipped forward onto another. It is divided into five grades, with grade one being the least advanced and grade five being the most advanced. The grades are listed below:

• Grade 1 – Upper vertebra has slipped forward less than 25 percent of the total width of the vertebral body.
• Grade 2 – Upper vertebra has slipped forward between 25 and 50 percent.
• Grade 3 – Upper vertebra has slipped forward between 50 and 75 percent.
• Grade 4 – Upper vertebra has slipped forward more than 75 percent.
• Grade 5 – Upper vertebra has slipped completely forward off the front of the lower vertebral body. Grade 5 is also known as spondyloptosis.

A treatment plan will be determined based on the severity of the slippage and symptoms. Understanding the spondylolisthesis definition by type and grade will give you a better sense of what your doctor will be explaining to you during your appointment.

Lumbar Spondylolisthesis vs. Cervical Spondylolisthesis

There is a difference between lumbar and cervical spondylolisthesis. The difference is the location of which the condition is present. When this condition affects the lumbar section of your spine, it is targeting your lower spine. When it affects the cervical section, it is targeting the upper section of your spine.

Lumbar spondylolisthesis is the most common form of this spinal health issue. If you are diagnosed with spondylolisthesis, it is more likely to be lumbar than cervical. Cervical spondylolisthesis is actually quite rare. It is generally the result of a neck injury or arthritis. It can also be congenital.

Diagnosing Lumbar Spondylolisthesis

Diagnosing lumbar spondylolisthesis is a simple process. There is a specific order of testing that your doctor will likely follow. Some people will only need the minimum amount of tests to diagnose lumbar spondylolisthesis, while others may need more advanced testing.

Basic Steps

1. Complete Medical History – You will be asked questions about your symptoms, as well as how the symptoms are affecting your daily life. Be prepared to give a complete detailed list of what positions or activities make your symptoms worse.
2. Physical Exam – Your doctor should examine you by checking your posture and the amount of movement you have in your lower back. Muscle strength, reflexes, and skin sensations are also a part of the physical exam.
3. X-Ray – An X-ray will be taken of your spine in different positions. X-rays can tell your doctor which vertebra is slipping and the degree it has slipped.

Sometimes more in depth information is required. If this is the case, the following tests could be ordered:

• Computed Tomography (CT scan) – A CT scan is a more detailed X-ray that allows your doctor to see sections of your body’s tissue.
• Myelography – If you are experiencing nerve problems, a myelography will be combined with the CT scan. A myelography consists of injecting a special dye into the space around the spinal canal. The dye will highlight the spinal nerves.
• Magnetic Resonance Imaging (MRI) – This is a machine that uses magnetic waves instead of X-rays to view your body’s soft tissues and nerves.

Treating Lumbar Spondylolisthesis

While surgery is an option, it is generally the last resort. The majority of cases will only require non-surgical treatment, including: rest, medication, and bracing. After a few days of this treatment, you will begin a non-surgical rehabilitation program.

This rehabilitation program will consist of physical therapy where you will visit a physical therapist a few times a week for four to six weeks. The goal for this program is to control your symptoms while you heal. Your physical therapist will work with you to determine the best positions and movements that minimize your pain.

Heat, cold, ultrasound, or electrical stimulation can be given to help ease pain and reduce muscle spasms. You will be taught the necessary exercises to help strengthen your abdominal and lower back muscles. Properly stretching tight muscles is an important step in rehabilitation. Although non-surgical treatment and rehabilitation is a better option than surgery, prevention is the best treatment for lumbar spondylolisthesis.

Isthmic Spondylolisthesis Definition

This condition occurs in the pars interarticularis part of your spine, which is a narrow area (isthmus) between the upper and lower articular processes. Isthmic spondylolisthesis is caused by healed or unhealed stress fractures that are surrounded by fibrous tissues. It occurs when the vertebra slips forward over the lower vertebra over a period of time.

It is commonly bilateral, meaning it occurs on both sides of the vertebra. These stress fractures separate the anterior (front) of the vertebra from the neural arch, which is the curved rear section of the vertebra that encloses the canal where the spinal cord passes. Repeat fractures and cycles of healing can eventually lengthen the pars interarticularis or the fracture itself. This can lead to further displacement of the affected vertebra, which can lead to increased spinal instability.

Who’s at Risk for Isthmic Spondylolisthesis?

While anyone could potentially be at risk for this condition, there are some more than others who could develop a fracture in the pars interarticularis. Common causes include:

• Bone does not form properly
• Accumulated physical stress causing weak vertebral structures to break
• Repeated heaving lifting, stooping, or twisting

Those who participate in gymnastics, weightlifting, football, pole vaulting, or any other sport that would involve hyperextension are at a higher risk for developing this condition.

Symptoms of Isthmic Spondylolisthesis

While pain is a possibility, not everyone will experience it. However, if pain is experienced, it is typically a deep ache in the lumbar area that can occasionally radiate into the buttocks or posterior thighs.

Here are the most common symptoms that you could experience:

• Leg weakness
• Sciatica
• Low back pain
• Muscle spasms
• Tight hamstring muscles
• Limp

Symptoms may not become present until adulthood; however, those active in hyperextension sports could develop symptoms as adolescents.

Diagnosing Isthmic Spondylolisthesis

The first step in diagnosing this condition is analyzing your medical history. Your doctor will ask you questions about your symptoms, the severity of your symptoms, and the treatments you have tried to relieve these symptoms.

The next step is a physical examination. During this exam, your doctor will test for any limitations of movement, balancing issues, and pain. You will also be tested for loss of reflexes, muscle weakness, any loss of sensation, and any other signs of neurological injury.

The final step in diagnosing is diagnostic testing. Generally, the first test you will take will be an x-ray. This type of spondylolisthesis can be seen on a lateral lumbar x-ray. If more tests are needed, then your doctor may order a CT scan or MRI to get a more detailed view of your spine’s tissues.

Treating Isthmic Spondylolisthesis

Treatment will depend on the severity of the vertebral slippage. Most doctors use the Meyerding Grading System to classify. This system bases the grade on a percentage of how much one vertebral body has slipped over the vertebral body underneath.

Your doctor will take this grade into consideration along with the severity of your symptoms when determining an effective treatment plan. The majority of cases do not require surgery. Some possible treatment options could include:

• Bed rest (short term)
• Restriction of activity
• Anti-inflammatory and/or pain medication (over-the-counter or prescribed)
• Muscle relaxants
• Steroids (oral/injections)
• Physical therapy
• Brace

If surgery is required for isthmic spondylolisthesis, there are different options available. Your doctor will consider the least invasive options first.

Degenerative Spondylolisthesis Definition

This is a spinal condition where a vertebra slips forward over the one below it. As your body ages, your bones, ligaments, and joints in the spine tend to become weak and are sometimes not able to support the spinal column in alignment.

This condition will usually occur in either the L4-L5 level of your lower spine, which is the most common location. It can also be present at the L3-L4 level. While it is a possibility that degenerative spondylolisthesis can be present in other levels, it is rare.

This version of spondylolisthesis can also occur in the cervical area (neck) of your spine; however, when this does happen, it is generally considered a secondary problem to arthritis in the facet joints.

Causes of Degenerative Spondylolisthesis

Your joints will undergo a degenerative process as you age. In each spinal vertebra, there are two joints that are composed of inferior and superior articular processes (facet joints). These facet joints are held in place by capsules (fibrous tissues). The capsules become thin as part of the normal aging process. They then weaken. This can cause the capsule to stretch and cause one vertebra to slide over another.

Two of the most common primary conditions that can lead to this version of spondylolisthesis are: osteoporosis and osteoarthritis. Osteoporosis can weaken your spinal bones, which can cause vertebral fractures that can cause the spinal bones to shift and then slip. Osteoarthritis can increase bone on bone contact. This can grind down the spinal bones causing them to slip.

Diagnosing Degenerative Spondylolisthesis

Your doctor will first review your medical history (symptoms). A physical examination will then be performed. You will be examined for physical symptoms, which include range of motion, flexibility, muscle weakness and/or neurological symptoms.

Diagnostic tests will be performed if the doctor suspects spondylolisthesis after the medical history and physical exam. The first diagnostic test will be an X-ray. If further tests are needed, it is possible an MRI scan may be ordered for a more in depth look.

Symptoms of Degenerative Spondylolisthesis

• Lower back pain
• Muscle spasms
• Pain with radiation to the buttocks and/or legs
• Lower extremity weakness or numbness – (RARE)
• Pain comes on with activity (example: during walking)

Treating Degenerative Spondylolisthesis

Prevention is the best way to treat this condition. Take steps early to prevent age related health conditions, such as osteoporosis and osteoarthritis that lead to degenerative spondylolisthesis. A treatment plan is based on your symptoms.

Bed rest for one to two days could help to relieve immediate discomfort. Your doctor may also prescribe an anti-inflammatory and/or pain medication to help alleviate symptoms. If needed, your doctor may also prescribe an epidural steroid injection to alleviate inflammation.

It is possible you will be given a brace to help stabilize your spine. It can be worn as needed for a short period of time. Physical therapy is also an option to increase back conditioning. Muscle strengthening helps to reduce the frequency and intensity of spasms.

Surgery is an option, but will not be considered unless there is an acute neurologic deficit, such as significant leg weakness or if the slippage is pulling on the nerves exiting the spinal canal causing pain, numbness, and/or weakness. Surgery is a last resort. If surgery is necessary for degenerative spondylolisthesis, it will require fusing the slipped vertebrae to the adjacent vertebrae.