Spondylolisthesis is the misalignment of one vertebra in relation to another. This can be in any direction, but the most common problem is when the upper vertebra slips forward on the lower vertebra.
Lumbar Spondylolisthesis Causes
The two most common types of spondylolisthesis are "degenerative" and "isthmic." Degenerative type typically occurs at L4-5 and is associated with degenerative changes of the stabilizing joints (facet joints) in the back of the spine and the disc. This type of spondylolisthesis is most commonly associated with lumbar stenosis that creates nerve root compression and resultant leg pain.
The isthmic type more commonly occurs at L5-S1 and is related to a defect in the "isthmus" or "pars" of the vertebra. This defect causes a discontinuity between the front part of the vertebra with the back part of the vertebra and allows a slippage to occur. There is a strong genetic component to this type of spondylolisthesis, with 50% of certain innuits (Eskimos) having this condition. Also, athletes involved in repetitive extension loading of the lumbar spine have a higher rate of this condition (gymnasts and football players).
Lumbar Spondylolisthesis Symptoms
Often there are no symptoms associated with spondylolisthesis. However, in symptomatic individuals, low back pain and leg pain are typical findings. In patients with concomitant spinal stenosis, leg pain and numbness are common. These findings are usually exacerbated by standing and walking and improve with sitting. Extension of the lumbar spine aggravates symptoms, and flexion can improve symptoms. Leg weakness can develop in some patients, but this is not the rule.
Diagnosing Lumbar Spondylolisthesis
A good history and physical taken by the spine physician can provide suggestions of this diagnosis. A simple plain X-ray can make a definitive diagnosis, and more advanced imaging is not always necessary unless an interventional procedure is planned.
Nonsurgical Treatment of Lumbar Spondylolisthesis
No treatment is necessary in asymptomatic individuals. For athletes who have sports-related symptoms (usually back pain), the offending activity should be curtailed. Non-operative treatment cannot make any permanent realignment of the spine.
Interventional treatments for lumbar spondylolisthesis may include:
- Medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) can provide symptomatic relief.
- Physical therapy and/or exercises may improve lumbar stability and help with symptoms
- Epidural steroid injections and nerve root injections to help reduce swelling and treat acute pain that radiates to the hips or down the leg
Surgical Treatment of lumbar spondylolisthesis
The surgical procedure generally used to treat lumbar spondylolisthesis at Emory is: