Learn about spondylolisthesis symptoms, diagnosis, treatment options, and types including listhesis. Find ways to manage this condition and improve your quality of life.

Spondylolisthesis

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Iqra Mazhar

Overview

Spondylolisthesis is a spinal condition characterized by the forward displacement or slip of one of the bones or vertebrae. This condition can happen at any level of the spine, including the cervical and thoracic spine, but it&rsquo;s most common in the lumbar (lower back) region. 
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The average person is born with 33 individual bones (the vertebrae) that interact and connect through flexible joints called facets. When a person becomes an adult, they have only 24 vertebrae because some vertebrae at the bottom end of the spine fuse during normal growth and development. The vertebrae have flexible intervertebral discs between them that function as shock absorbers when an individual walks or runs.

The spine also comprises the spinal cord and nerves, which carry messages between the muscles and the brain, and the facet joints, which provide stability by controlling the movement of the spine similar to hinges. 
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Spondylolisthesis refers to the spinal condition when a vertebra slips out of its proper position onto the vertebra below it. It puts pressure on nerves and is a common cause of lower back pain.

The condition is twice as common in men than women in the U.S. Also, there are more cases among white people compared to other ethnicities<a href="#accordion">[6]</a>. 
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Both of these conditions are common causes of low back pain in children and adults. Given that they present with similar symptoms, it&rsquo;s easy to get confused between the two; however, they are not the same.

Spondylolysis is a stress fracture or weakness in one of the vertebrae. It is commonly seen in young athletes but can also occur in children as young as six-years-old. It may even be present in older people with no known injury or sports participation. It usually occurs in the 5th vertebra of the lumbar spine, but it can affect the 4th lumbar vertebra. The fracture can be on one or both sides of the bone.

On the other hand, spondylolisthesis means the vertebra has slipped out of its original place. Often, spondylolysis leads to spondylolisthesis, i.e., stress fractures weaken the bone to the extent that it cannot maintain its position in the spine and shift forward onto the vertebrae directly below it. Many cases of spondylolisthesis occur in children and adolescents because of the growth spurt. 
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Here are some types of spondylolisthesis:

<ol>
	<li>Congenital Spondylolisthesis:This is caused by abnormal spinal development before birth. It increases their risk for slippage later in life. 
	&nbsp;</li>
	<li>Isthmic Spondylolisthesis:This is caused due to spondylolysis, i.e., a defect in the pars interarticularis, a small bony structure that connects the upper and lower facets of the vertebra. The fracture or crack is responsible for weakening the bone. 
	&nbsp;</li>
	<li>Degenerative Spondylolisthesis:This is caused by age-related pressure on the spine. With time, the discs become thin and slip out of place. 
	&nbsp;</li>
	<li>Traumatic Spondylolisthesis:This occurs due to a traumatic injury to the spine, such as a fall or car accident. 
	&nbsp;</li>
	<li>Pathologic Spondylolisthesis:This is a less common type of spondylolisthesis caused by a disease or condition, such as osteoporosis or bone cancer, that weakens the spine. 
	&nbsp;</li>
	<li>Postsurgical Spondylolisthesis:This is another rare type of spondylolisthesis that occurs due to spinal surgery, especially if the surgery removed a large portion of the facet joint. 
	&nbsp;</li>
</ol>

These types are further defined as either low-grade or high-grade based on the amount of slippage. Low-grade (Grades I and II) do not require surgery even though 25-50% of the vertebral body has slipped forward. Almost all cases of degenerative spondylolisthesis and the majority of cases of isthmic spondylolisthesis in adolescents are low-grade. 
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On the other hand, if more than 50% of the width of the fractured vertebra has slipped out onto the vertebra below it, it will be considered a high-grade (Grades III and IV) slip. These individuals will probably experience significant nerve injury and more pain and require surgery.

Grade V classification means the vertebral body of the patient has completely fallen and appears detached<a href="#accordion">[7]</a>. 
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Signs and Symptoms

The signs and symptoms of spondylolisthesis vary depending on the severity of the condition and the extent of the spinal slippage. Some individuals with spondylolisthesis may not experience any symptoms, while others may have significant pain and disability, causing difficulty walking or standing for a long time or bending over. 
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Common signs and symptoms of spondylolisthesis include:

<ol>
	<li><a href="https://merisehat.pk/disease/lower-back-pain">Lower Back Pain</a> -This is the most common symptom of spondylolisthesis and may be felt in the lower back, buttocks, or thighs. 
	&nbsp;</li>
	<li>Muscle Tightness And Spasms -The muscles in the lower back can become tight and go into spasms as they try to support the spine. 
	&nbsp;</li>
	<li>Stiffness And Limited Range Of Motion -The slippage of the vertebrae can cause stiffness and restricted movement in the lower back. 
	&nbsp;</li>
	<li>Numbness,Tingling, And Weakness -These sensations felt in the legs and feet occur due to pressure on the nerves exiting the spine. 
	&nbsp;</li>
	<li>Loss Of Bladder Or Bowel Control - In severe cases of spondylolisthesis, the nerves that control bladder and bowel function may be affected, leading to incontinence. 
	&nbsp;</li>
	<li>Visible Deformity - In some cases, the slippage of the vertebrae is visible as a bump or hump in the lower back. 
	&nbsp;</li>
</ol>

Note: Not all individuals with spondylolisthesis will experience symptoms. The severity of symptoms also varies widely from person to person. If you or a loved one is experiencing any of the above symptoms, speak to a doctor to determine the underlying cause and appropriate treatment plan. 
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Causes

The causes of spondylolisthesis can vary depending on the type of the condition, and some cases may have multiple contributing factors.

<ul>
	<li>Overextending of the spine</li>
	<li>Genetics</li>
	<li>Age-related wear and tear 
	&nbsp;</li>
</ul>

Screening for spondylolisthesis is particularly important for individuals with an increased risk. E.g., athletes who participate in high-impact sports or those with a family history of spondylolisthesis.

It is also important for individuals with symptoms, such as lower back pain, muscle spasms, or numbness and tingling in the legs. 
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Diagnosis

The diagnosis of spondylolisthesis typically involves a combination of medical history, physical examination, and imaging studies.

The healthcare provider will take a detailed medical history to assess risk factors, symptoms, and other potential underlying conditions that may contribute to back pain. They may also perform a physical exam to look for signs of spinal deformity, nerve function, and range of motion in the spine. 
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Additionally, the doctors may order some diagnostic tests:

<ol>
	<li>X-Rays: X-rays are often the first imaging study to evaluate the spine. It helps identify any vertebral slippage or other structural abnormalities. 
	&nbsp;</li>
	<li>Magnetic Resonance Imaging (MRI): MRI may be used to assess for nerve compression or other soft tissue abnormalities that contribute to symptoms. 
	&nbsp;</li>
	<li>Computed Tomography (CT): CT scans may be used to obtain more detailed images of the spine to evaluate the severity of vertebral slippage. 
	&nbsp;</li>
	<li>Bone Scan: A bone scan can assess bone abnormalities and identify areas of increased activity that may indicate a stress fracture or other underlying condition. 
	&nbsp;</li>
</ol>

Treatment

The treatment for spondylolisthesis depends on the severity of the condition and the presence of symptoms.

<ol>
	<li>Conservative Treatment: This includes rest, physical therapy, anti-inflammatory medications, and a change in routine activities to reduce stress on the spine. 
	&nbsp;</li>
	<li>Bracing: In some cases, a back brace may be recommended to help stabilize the spine and reduce pain. 
	&nbsp;</li>
	<li>Surgery: Surgery may be recommended in severe cases of spondylolisthesis where conservative treatment options have not provided relief, and the slippage is causing severe nerve compression or other complications. Surgical options include spinal fusion or decompression surgery. 
	&nbsp;</li>
	<li>Epidural Steroid Injections: For patients with nerve-related pain, epidural steroid injections may be recommended to reduce inflammation and provide pain relief. 
	&nbsp;</li>
</ol>

Note: Many individuals may not experience significant symptoms and, therefore, not require any treatment. If you experience symptoms, seek medical treatment immediately. A healthcare provider helps determine which treatment option is best for your individual needs and circumstances. 
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Complications of spondylolisthesis can occur when the forward displacement or slip of the vertebrae causes compression or irritation of nerves or other structures in the spine. 
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Some potential complications of spondylolisthesis include:

<ol>
	<li>Nerve Compression: When the vertebrae slip out of alignment, they can put pressure on the nerves in the spinal column, causing pain, numbness, tingling, or weakness in the legs and feet. 
	&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/spinal-stenosis">Spinal Stenosis</a>: Spondylolisthesis can narrow the spinal canal, leading to a condition known as spinal stenosis. This causes compression of the spinal cord or nerve roots. It may result in pain, weakness, or numbness in the legs and feet. 
	&nbsp;</li>
	<li>Loss Of Bladder Or Bowel Control: In severe cases, nerve compression can lead to loss of bladder or bowel control, a medical emergency that requires immediate attention. 
	&nbsp;</li>
	<li>Chronic Pain: Spondylolisthesis can cause chronic pain in the lower back and legs, which affects the quality of life. 
	&nbsp;</li>
	<li>Reduced Mobility: Severe spondylolisthesis can lead to reduced mobility and limitations in range of motion that affects a person&#39;s ability to perform daily activities. 
	&nbsp;</li>
</ol>

Several risk factors can increase the likelihood of developing spondylolisthesis, including:

<ol>
	<li>Age</li>
	<li>Genetics</li>
	<li>Trauma 
	&nbsp;</li>
</ol>

It is important to note that having one or more risk factors does not necessarily mean that an individual will develop spondylolisthesis. 
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Some of the preventative measures that can be taken to reduce the risk of developing spondylolisthesis or to prevent the condition from worsening include:

<ol>
	<li>Maintaining A Healthy Weight: Excess weight places additional stress on the spine. A balanced diet and regular exercise can help maintain a healthy weight. 
	&nbsp;</li>
	<li>Engaging In Safe Physical Activity: Certain activities, such as contact sports or weightlifting, can place additional stress on the spine and increase the risk of spondylolisthesis. Engaging in safe physical activities and using proper techniques can help reduce this risk. 
	&nbsp;</li>
	<li>Practicing Good Posture: Poor posture increases stress on the spine and the risk of spondylolisthesis. Practicing good posture, particularly when sitting or standing for long periods, can help reduce this risk. 
	&nbsp;</li>
	<li>Building Strong Core Muscles: Strong core muscles can help support the spine and reduce the risk of spondylolisthesis. Exercises that strengthen the core, such as planks or abdominal crunches, can help reduce this risk. 
	&nbsp;</li>
	<li>Seeking Prompt Medical Attention: This is important if an injury or trauma to the spine occurs to reduce the risk of spondylolisthesis or prevent the condition from worsening. 
	&nbsp;</li>
</ol>

Key Points

<ul>
	<li>Spondylolisthesis is a spinal condition where one vertebra slips out of place onto the vertebra below it, which can cause lower back pain.</li>
	<li>The condition can be caused by a variety of factors, including congenital defects, degenerative changes, trauma, or repetitive stress.</li>
	<li>Spondylolisthesis can be diagnosed through physical examination, imaging studies, and nerve conduction studies.</li>
	<li>Treatment options for spondylolisthesis include conservative measures such as rest and physical therapy as well as surgical options such as spinal fusion or decompression surgery.</li>
	<li>Complications of spondylolisthesis can include nerve compression, spinal instability, and spinal deformity.</li>
	<li>Risk factors for developing spondylolisthesis include age, sex, genetics, and lifestyle factors such as obesity or participation in certain sports or activities.</li>
	<li>Recent research on spondylolisthesis has focused on improving surgical techniques, evaluating the effectiveness of physical therapy and exercise programs, and investigating the relationship between spondylolisthesis and spinal curvature. 
	&nbsp;</li>
</ul>

[1] Patil SS, Rawall S, Nagaraj S, Nagathan VM. Prevalence and clinical significance of incidental and symptomatic spondylolisthesis in Indian population: A cross-sectional study. J Craniovertebr Junction Spine. 2018 Jul-Sep;9(3):162-167. doi: 10.4103/jcvjs.JCVJS_12_18. PMID: 30546247; PMCID: PMC6284252.

[2] Ahmed SI, Muzaffar N, Ahmed M, Shoaib M, Anjum R. Prevalence and Patterns of Spondylolisthesis in an Urban Population of Pakistan. Cureus. 2021 Feb 24;13(2):e13513. doi: 10.7759/cureus.13513. PMID: 33717733; PMCID: PMC7941137.

[3] Rathod VR, Pathak A, Nayak NR, Faye A. Non-surgical treatment of degenerative spondylolisthesis. J Clin Orthop Trauma. 2017 Apr-Jun;8(2):173-176. doi: 10.1016/j.jcot.2016.12.006. Epub 2016 Dec 19. PMID: 28540109; PMCID: PMC5420045.

[4] Yagi M, Hasegawa K, Kato S, Machida M, Airaksinen O, Ohashi M, et al. Minimally invasive surgery for degenerative spondylolisthesis: a systematic review and meta-analysis. Spine (Phila Pa 1976). 2021;46(4):E239-E246. doi: 10.1097/BRS.0000000000003761.

[5] Park YS, Lee HS, Shin JK, Kim SW, Kim TH, Lee JS. The effects of a targeted exercise program on pain and function in patients with degenerative spondylolisthesis: a randomized controlled trial. J Orthop Surg Res. 2020;15(1):340. doi: 10.1186/s13018-020-01852-8.