Spondylolisthesis
Spondylolisthesis is slippage of a lumbar vertebra in relation to the vertebra below it. Anterior slippage (anterolisthesis) is more common than posterior slippage (retrolisthesis). Spondylolisthesis has multiple causes. It can occur anywhere in the spine and is most common in the lumbar and cervical regions. Lumbar spondylolisthesis may be asymptomatic or cause pain when walking or standing for a long time. Treatment is symptomatic and includes physical therapy with lumbar stabilization.
There are five types of spondylolisthesis, categorized based on the etiology:
Type I, congenital: caused by agenesis of superior articular facet
Type II, isthmic: caused by a defect in the pars interarticularis (spondylolysis)
Type III, degenerative: caused by articular degeneration as occurs in conjunction with osteoarthritis
Type IV, traumatic: caused by fracture, dislocation, or other injury
Type V, pathologic: caused by infection, cancer, or other bony abnormalities
Spondylolisthesis usually involves the L3-L4, L4-L5, or most commonly the L5-S1 vertebrae.
Types II (isthmic) and III (degenerative) are the most common.
Type II often occurs in adolescents or young adults who are athletes and who have had only minimal trauma; the cause is a weakening of lumbar posterior elements by a defect in the pars interarticularis (spondylolysis). In most younger patients, the defect results from an overuse injury or stress fracture with the L5 pars being the most common level.
Type III (degenerative) can occur in patients who are > 60 and have osteoarthritis ; this form is six times more common in women than men.
Anterolisthesis requires bilateral defects for type II spondylolisthesis. For type III (degenerative) there is no defect in the bone.
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Spondylolisthesis is graded according to the percentage of vertebral body length that one vertebra subluxes over the adjacent vertebra:
Grade I: 0 to 25%
Grade II: 25 to 50%
Grade III: 50 to 75%
Grade IV: 75 to 100%
Spondylolisthesis is evident on plain lumbar x-rays. The lateral view is usually used for grading. Flexion and extension views may be done to check for increased angulation or forward movement.
Mild to moderate spondylolisthesis (anterolisthesis of ≤ 50%), particularly in the young, may cause little or no pain. Spondylolisthesis can predispose to later development of foraminal stenosis . Spondylolisthesis is generally stable over time (ie, permanent and limited in degree).
Treatment of spondylolisthesis is usually symptomatic. Physical therapy with lumbar stabilization exercises may be helpful.
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- Weill Cornell Medicine
- Diagnosing and Treating Spondylolisthesis
- Symptoms of Spondylolisthesis
- Surgery for Spondylolisthesis
- Doctors Who Treat Spondylolisthesis
- ALIF, TLIF, and LLIF for Spondylolisthesis
Since there can be so many different causes of back pain, an accurate diagnosis is very important. People usually see their primary care physician or general practitioner first about their back pain; that doctor will probably perform a physical exam first and then order imaging tests to see what’s causing the pain.
X-ray: an X-ray can show which vertebrae have slipped out of place.
Computerized tomography (CT) is a noninvasive procedure that uses x-rays to produce a three-dimensional image of the spine, particularly of the bone. A CT shows more detail than an X-ray, and can identify any fractures of the bone.
Magnetic resonance imaging (MRI): An MRI uses magnetic fields and radio-frequency waves to create an image of the spine, and can reveal fine details of the spine, including nerves, tumors, and other details. An MRI scan can show details in the spine that can’t normally be seen on an X-ray or CT. Sometimes a contrast agent is injected into a vein in the hand or arm during the test, which highlights certain tissues.
Myelogram: This test uses a dye that is injected directly into the spinal column, and is used in conjunction with an X-ray or CT Scan.
Treatment Options
Treatments for spondylolisthesis vary depending on the grade of the slippage, severity of the condition, and the age and health of the patient. Non-invasive, conservative treatment options include:
- Avoiding heavy lifting or strenuous activities
- Non-steroidal medications such as ibuprofen to reduce milder inflammation and pain
- Steroid injections to reduce more serious inflammation and pain
- Bracing to stabilize the spine and reduce pain
Physical therapy to strengthen the core muscles surrounding the spine. Physical therapy is usually prescribed in approximately 8- to 12-week regimens.)
Surgery: If conservative treatments offer no relief, then surgery may be required. The goal of surgery is to relieve nerve pain, stabilize the spine, and increase a person’s ability to move.
Spine surgery has advanced in recent years so that many procedures are minimally invasive. This type of minimal access surgery causes less trauma than older surgical methods and requires much less time in the hospital. The incision is smaller and avoids muscle trauma, which allows patients to resume regular activity within a short period of time. Surgery for spondylolisthesis is best performed at a major spine center with doctors trained and experienced in the most up-to-date, minimally invasive techniques. Minimally invasive surgery means a quick recovery, less pain, and less scarring. (See Surgery for Spondylolisthesis .)
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Reviewed by:Paul Park, MD Last reviewed/last updated: April 2024
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The goals of treatment for spondylolysis and spondylolisthesis are to: Reduce pain; Allow a recent pars fracture to heal; Return the patient to sports and other daily activities; Nonsurgical Treatment. For most patients with spondylolysis and low-grade spondylolisthesis, back pain and other symptoms will improve with nonsurgical treatment.
Nonsurgical Treatment Although nonsurgical treatments will not repair the vertebral slippage, many patients report that these methods help relieve symptoms. Physical therapy and exercise.
Nonsurgical treatments may include activity reduction, a back brace, physical therapy and/or corticosteroid injections. In severe cases, spine surgery may be required to alleviate chronic pain or nerve damage.
Treatment of Spondylolisthesis. Measures to relieve pain and stabilize the spine. One to two days of bed rest may provide pain relief for people with spondylolisthesis. Longer bed rest weakens the core muscles and increases stiffness, thus worsening back pain and prolonging recovery.
Spondylolisthesis is when one of your vertebrae moves out of place. This sometimes leads to back pain and other symptoms. It can be usually treated with rest, medication, and/or physical...
Treatment is symptomatic and includes physical therapy with lumbar stabilization. There are five types of spondylolisthesis, categorized based on the etiology: Type I, congenital: caused by agenesis of superior articular facet. Type II, isthmic: caused by a defect in the pars interarticularis (spondylolysis)
Treatments for spondylolisthesis vary depending on the grade of the slippage, severity of the condition, and the age and health of the patient. Non-invasive, conservative treatment options include: Avoiding heavy lifting or strenuous activities. Non-steroidal medications such as ibuprofen to reduce milder inflammation and pain.
weightlifting. Spondylolysis is often a precursor to spondylolisthesis. Spondylolysis occurs when there is a fracture in a vertebra, but it hasn’t yet fallen onto a lower bone in your spine....