What is Spondylolisthesis?

Spinal Vertebral Bone and Intervertebral Disc
Spinal Vertebral Bone and Intervertebral Disc. BSIP/UIG/Collection:Universal Images Group/Getty Images

What is Spondylolisthesis?

Spondylolisthesis occurs when a vertebra slips out of place relative to the vertebra beneath it. This slippage can be an anteriolithesis or a retrolithesis.

Who is At Risk for Spondylolisthesis?

Children involved in sports such as gymnastics and diving have a high incidence of spondylolisthesis. These and other sports put a lot of stress on the back, especially the movement of hyperextension (bending backwards).

Spondylolisthesis also occurs in adults after the age of 40, due to degeneration.

Causes of Spondylolisthesis

Spondylolysis is the most common cause of spondylolisthesis. This ususally starts with a problem in an area of the facet joint known as the pars.  Over time, especially if it's not treated, the pars injury or defect can develop into spondylolysis.  Once the slippage occurs, the spondylolysis becomes spondylolisthesis.  Genetics sometimes predisposes people to the initial pars defect, but not always; this is called dysplastic spondylolisthesis. 

Other causes include degenerative or arthritic changes in the spine, trauma, or bone disease such as a tumor.

Grades of Spondylolisthesis

Spondylolisthesis is measured in grades (degrees) of slippage. There are 4 grades., each representing 25% slippage. So, for example, if a patient is measured to have a Grade 2 Spondylolisthesis, this means that the 2 adjacent vertebra maintain a 50% contact with one another.

Grades are measured by taking a side view X-Ray.

Other diagnostic methods, such as CT scans or MRIs might be used to determine the damage to surrounding tissues.

Treatment for Spondylolisthesis:

Spondylolisthesis is treated according to the Grade. For grades 1 and 2, conservative treatment, including physical therapy, home exercises, stretching and the use a brace are often given.  Are these effective?

A 2003 systematic review published in the journal Manual Therapy found that specific exercise interventions given either alone or in combination with other treatments, may possibly relieve low back pain.  Beyond that, the researchers say, they don't have enough specific information to impart about what works and what doesn't.

Fast forward 10 years later, and another systematic review, also published in Manual Therapy, reported that no consensus could be reached as to whether nonoperative care (examples of nonoperative treatment include physical therapy and medications) was more effective than getting surgery.  But before you rush out to visit a neurosurgeon, consider that the studies in the review, according to the authors, had a number of limitations. 

Higher Grades of Spondylolisthesis may require fusion surgery, but this treatment may not be effective either.  A systematic review conducted by the Cochrane Database found that results of studies assessing surgery (and other treatments) for spondylolisthesis conflicted with one another.  Consequently, the researchers  concluded that some aspects of surgery may be useful, while others are in question.  They also said more studies on this topic are needed.

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