What Is Spondylolisthesis? Its causes and treatments
Lower back pain can take a toll on your entire body. This particular health concern is reported among men and women equally, affecting about 80% of people at some point in their lives. While there are many factors that can lead to lower back pain, a condition called spondylolisthesis is one of the most common causes. This article will cover what you should know about the condition and how to find relief.
Spondylolisthesis is a spinal condition that can lead to pain and discomfort in the lower back. It occurs when one of the bones (vertebrae) in the spine moves out of place and onto the bone below it. If the bone slips too much, it can even press on surrounding nerves.
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This can occur for many reasons. In children and young adults, it is usually due to a birth defect or periods of rapid growth, also known as growth spurts. It’s also more likely to occur in athletes who frequently overstretch the lower back. This may include gymnasts, football players, and weight lifters.
Doctors believe there is also a genetic component to spondylolisthesis. Some people are born with thin vertebral bones that are more susceptible to fractures. These fractures can lead to the slippage associated with spondylolisthesis.
There are several different ways to classify spondylolisthesis. The following types are based on the initial cause of the condition.
- Degenerative spondylolisthesis: This is the most common form of spondylolisthesis, which is simply due to aging. As the years go on, discs between your bones lose water and become less effective in cushioning each vertebral bone. This occurs from basic wear and tear on your body.
- Congenital spondylolisthesis: By definition, congenital means “present at birth.” Abnormal bone formation can put a person at greater risk for developing this condition.
- Isthmic spondylolisthesis: As we’ll discuss later in this article, spondylolisthesis can occur as a result of spondylolysis. This is when stress fractures weaken the bone, causing it to slip out of place.
- Traumatic spondylolisthesis: This is when an injury leads to fractures and subsequent slipping. This may be the result of athletic activity or a fall.
- Pathological spondylolisthesis: The spine can weaken from diseases like osteoporosis or even a temporary infection. Pathological spondylolisthesis takes place after this type of health event.
- Post–surgical spondylolisthesis: Slippage that occurs or becomes worse after spinal surgery.
Spondylolysis is also divided up into several different grades based on severity. This helps doctors determine the best course of treatment for a specific case. Slippage is graded on a scale of one to five.
- 25% or less of the vertebral body has slipped forward
- Between 26-50% of the vertebral body has slipped forward
- Between 51-75% of the vertebral body has slipped forward
- Up to 76-100% of the vertebral body has slipped forward
- The vertebral body has completely slipped off and looks detached
Your doctor will determine the best type of treatment based on your personal situation. However, Grade 1 and grade 2 slips generally don’t require surgery. In many cases, these patients respond well to conservative and non-invasive methods of treatment.
Slips that are rated above grades 1 and 2 may require surgery if significant pain persists.
Spondylolisthesis vs. Spondylolysis
As previously mentioned, a condition called spondylolysis often leads to spondylolisthesis. It occurs when there is a fracture in the bone, but it hasn’t yet fallen onto a lower bone in your spine. In most cases, patients with spondylolysis will also have some degree of spondylolisthesis.
The two conditions are so similar that they come with the same set of symptoms. For this reason, your doctor will need to conduct imaging tests, such as X-rays, computerized tomography (CT) scans, or magnetic resonance imaging (MRI) scans. This is the best way to look at what is happening in the spinal area and confirm a diagnosis.
Do I have it? 4 common spondylolisthesis symptoms
In some cases, patients with spondylolisthesis don’t have symptoms and aren’t aware of the condition. This is generally true for mild forms. On the other hand, those with severe cases may not be able to go about simple activities.
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Here are four common spondylolisthesis symptoms.
Persistent lower back pain is the most common symptom of this condition. It will feel much like a muscle strain that worsens with activity.
This pain can also radiate down to the buttocks and back of the thighs.
Tenderness associated with spondylolisthesis can lead to stiffness in the lower back and legs.
This usually makes it difficult for patients to walk or stand for long periods of time.
Spasms can lead to tight hamstrings (the muscles in the back of the thigh).
As this type of pain progresses, tingling and numbness can travel all the way down to the feet. This is a result of pressure on the spinal nerve root as it exits the spinal canal near the fracture.
Weakness in one or both legs can occur in many cases of spondylolisthesis.
Like muscle spasms, this is due to pinching of the spinal nerve root and can lead to changes in posture and gait.
How do you fix spondylolisthesis?
If you believe you may be suffering from spondylolisthesis, it’s important to talk to your doctor. After a thorough review of your symptoms and medical history, various tests will help your doctor confirm a diagnosis.
Luckily, there are a wide variety of spondylolisthesis treatment options. Your doctor will start with conservative methods of pain relief before suggesting more invasive procedures.
These are some of the more common ways patients find relief from their pain and other symptoms.
Lower back pain can make exercising feel impossible, but it’s one of the best ways to minimize spondylolisthesis symptoms. With a gentle routine, you can maintain a healthy weight and increase your flexibility.
Some exercises focus on stretching and lengthening, while others are meant for strengthening the muscles of the spine and abdomen for better support. This is a prescription for both treatment and prevention of future lower back pain.
Once your doctor clears you for exercise, try a few simple stretches each day. Concerned about whether you’re doing them correctly? Work with a physical therapist or qualified personal trainer. They can teach you how to perform each exercise in a way that will prevent further injury.
Yoga is a form of exercise that focuses specifically on stretching, lengthening, and strengthening. In fact, many of the best exercises for lower back pain are poses commonly found in yoga classes. Find a reputable studio that offers private lessons or classes that are designed to be gentle on those with injuries.
Experts advise anyone with spondylolisthesis to approach poses slowly and gently. If you feel pain, stop immediately. Back bends and poses that require twisting and bending forward aren’t recommended. A professional yoga instructor or physical therapist can help you determine the best poses for your condition. Before trying a class, be sure to inform the instructor of your condition.
Back brace for spondylolisthesis
A back brace is an affordable and effective tool that can help you perform basic activities during a mild and short-term pain flare-up. They also limit your range of motion to promote healing and prevent further injury.
Other benefits of back braces for lower back pain can include:
- Posture improvements
- Ease of use
- Affordability
- Availability
- Compression
Back braces work best in combination with other forms of treatment like physical therapy and medications. Talk to your doctor about whether this may be a promising form of treatment for your lower back pain, and take a look at our list of back braces.
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Spondylolisthesis physical therapy
Physical therapy is a great way to treat a range of lower back pain causes. Even better, most insurance companies cover this type of treatment.
A professional physical therapist develops a routine to help you build up core muscles in the midsection of your body, including your back. You will also practice targeted stretching to improve your flexibility and relieve muscle pain. Physical therapy can strengthen the muscles that support your spine, helping you prevent further injury.
You are usually assigned a number of exercises to perform each day on your own. This will help you maximize the benefits of your time in physical therapy.
Chiropractic care for spondylolisthesis
Chiropractic care is a form of complementary and alternative medicine. It continues to grow in popularity as a cost-effective and successful way of relieving lower back pain.
A chiropractor will use various manipulation techniques to adjust and correct your alignment. They believe that a natural balance needs to be maintained in order for the body to function optimally. Targeted and controlled forces will be applied to specific joint areas that are limiting movement. Patients often report relief from muscle tightness and pain, as well as better range of motion.
A wide range of medications can be helpful in reducing the lower back pain associated with spondylolisthesis.
Your doctor may first recommend nsaids because of their anti-inflammatory properties. Basic over-the-counter nsaids include drugs like aspirin and ibuprofen. In general, these medications are best for short-term relief to avoid side effects of prolonged use.
In severe cases of spondylolisthesis, your doctor may prescribe something stronger for pain management. However, prolonged use of pain medications is associated with a number of side effects and concerns in regarding misuse and addiction. Always talk with your healthcare team about your pain level and health concerns to determine the best medications for your specific case.
If conservative treatment options aren’t giving you the pain relief you need, but you aren’t ready to consider surgery, your doctor may recommend injections. This is a minimally invasive procedure that can have significant benefits.
Epidural steroid injections are the most common type of injection for lower back pain with spondylolisthesis. These injections involve a combination of a corticosteroid and numbing agent delivered into the epidural space of the spine. The drugs work to reduce inflammation and pain. This relief can last for weeks or years, depending on the case. Most patients can resume normal activities the following day.
You can learn more about this procedure in the following video.
Non-invasive treatment for mild cases of spondylolisthesis is successful in about 80% of cases. Unfortunately, if you are still experiencing pain that disrupts your everyday routine, your doctor may suggest surgery. In severe cases where the bones of your spine are pressing on your nerves, this may be the only way to fix the issue.
A spinal fusion is one of the most common operations to help patients suffering from spondylolisthesis. In this surgery, bone grafts are placed between vertebrae to help them fuse together. Your doctor will also use screws and rods to hold the vertebrae together as they heal. It will typically take four to eight months for the bones to fully fuse together, but spinal fusion success rates are typically high.
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