Spondylolisthesis

What are the Causes of Spondylolisthesis?

Spondylolisthesis can be caused by several factors, including:

• Congenital Defects: Some individuals are born with a defect in part of the spine that can lead to spondylolisthesis.
• Degenerative Changes: Age-related wear and tear, such as arthritis, can weaken the spine and cause vertebrae to slip.
• Trauma: Injury or stress fractures can cause a vertebra to slip out of place.
• Overuse: Repetitive stress from activities like gymnastics or weightlifting can lead to spondylolisthesis.
• Traumatic spondylolisthesis – fractures of the pars interarticularis or the facet joint of spine following high velocity trauma
• Pathologic spondylolisthesis – defect in the bone due to infection, neoplasm, post-surgery in lumbar spine

What is the Anatomy of Spondylolisthesis in the Spine?

The spine is made up of a series of vertebrae stacked on top of each other. Spondylolisthesis occurs when one of these vertebrae slips forward relative to the vertebra below it. This slippage can compress the spinal cord or nerve roots, leading to pain and other symptoms. The lumbar spine is the area most commonly affected, particularly at the L4-L5 level.

• Spondylolisthesis most commonly occurs in the lower lumbar spine but rare in the cervical spine and thoracic spine expect for trauma
• Degenerative spondylolisthesis is the commonest form seen in adults
• Isthmic spondylolisthesis is more common in the adolescent

What are the Common Symptoms Associated with Spondylolisthesis?

Severity of symptoms is based degree of slippage

Common symptoms of spondylolisthesis include:

• Back pain – commonest symptom – typically worse with prolonged standing, bending and lifting and often relieves on lying down or sitting
• Pain, numbness and weakness in legs (Sciatica) – as the spine becomes unstable and put pressure on nerves (stenosis)
• Neurogenic claudication – buttock and leg pain and cramps caused by walking for short distance, but pain subsides on rest
• Loss of bowel and bladder function in cases of severe nerve compression

If I Have Spondylolisthesis, Should I See a Spine Doctor Always?

Yes, it is advisable to see a spine doctor if you suspect spondylolisthesis, especially if:

• You experience persistent lower back pain or stiffness.
• You notice pain that radiates into your legs or feet and at rest
• You have numbness, tingling, or weakness in the lower extremities.
• Your symptoms interfere with your daily activities or mobility.

Can I Treat My Spondylolisthesis with Household Remedies?

Mild cases of spondylolisthesis can sometimes be managed at home with:

• Rest: Avoid activities that exacerbate the pain.
• Ice/Heat Therapy: Applying ice or heat to reduce pain and inflammation.
• Over-the-Counter Pain Relievers: Medications like ibuprofen or acetaminophen can help alleviate pain.
• Gentle Exercise: Stretching and strengthening exercises may help improve symptoms.
• Proper Posture: Maintaining good posture to reduce stress on the spine.

What are the Treatment Options for Spondylolisthesis?

Treatment options for spondylolisthesis include:

• Medications: Anti-inflammatory drugs, non-opioid analgesic  and muscle relaxants.
• Physical Therapy: Exercises to strengthen the core muscles and improve spinal stability.
• Bracing: A back brace can help support the spine and reduce pain, does not have long term benefits but only for short periods
• Caudal epidural Steroid Injections: To reduce inflammation around the affected nerves.
• Traction – No role
• Surgery: In severe cases, surgery may be necessary to stabilize the spine and relieve pressure on the nerves.

When is Surgery for Spondylolisthesis Required?

Surgery may be required for spondylolisthesis when:

• Non-surgical treatments have not provided sufficient relief.
• There is significant nerve compression leading to weakness, numbness, or loss of function.
• Symptoms are severe enough to interfere with daily activities or quality of life.
• Progressive spondylolisthesis – Slippage that is progressively worsening
• Back pain that has not improved after a period of nonsurgical treatment

What are the surgical options for spondylolisthesis

Decompression – This essential procedure is used when the spine remains stable with grade I listhesis

Aim – To relieve compression on the nerve

Plan- It involves the removal of a small amount of bone and disc material to create additional space for the nerves within the spinal canal done by small incision

Spinal Fusion– This procedure is indicated for cases with progressive slippage of grade II or higher

Aim –  To prevent further slippage, stabilize the spine, and decompress the nerve

Plan – It involves the removal of bone and disc material which is replaced by interbody cage and fixed by screw and rods to stabilise the spine performed through keyhole incision

What can you expect after surgery?

Most patients typically spend just 1 to 3 days in the hospital. In fact, many are up and walking the very next day! Returning to your normal activities will depend on your overall health, wound is healing, and your surgeon’s guidance. With proper care and attention, you can look forward to a smooth recovery and getting back to your routine in no time.