Spondylolisthesis refers to a spine condition where one vertebra is slipped in relation to another vertebra. This may or may not produce symptoms in a patient with the condition. There are several types of spondylolisthesis, depending on what causes the slip. The two most common types are degenerative spondylolisthesis and isthmic/lytic spondylolisthesis.
Degenerative spondylolisthesis occurs when osteoarthritis of the spine weakens that segment of the spine, allowing the vertebra to slip forward or backward. This may create back pain, sciatica or radiculopathy, or stenosis. However, degenerative spondylolisthesis is quite common, and there are many people who have this condition and do not know it. Having the condition does not mean you require treatment, however, if you do know you have it, there are certain activities that should be avoided if possible. In addition, maintaining an appropriate weight and a strong muscle core can support the spine in a way that can decrease symptoms from spondylolisthesis.
Isthmic/Lytic spondylolisthesis occurs when an area of the vertebra called the pars interarticularis is fractured, and this allows the vertebra to slip forward. Most often, this starts in adolescent years, and is more common in high level activities that place the spine into hyper-extension (backward) positions. The micro-fractures which are created during this time can either heal completely with bone, heal with scar tissue, or not heal at all. It is important to see a medical professional if a teenager has ongoing back pain of unknown cause in order to rule out this condition. Often at this point in time, rest and/or bracing will slow or stop the process.
In cases that do not heal, this can sometimes lead to spondylolisthesis. However, approximately 6% of the population has fractures of the pars or isthmic spondylolisthesis, and many people do not even know it. Many people live normal lives, without back pain. However, in some people, isthmic spondylolisthesis can lead to symptoms. As we age, patients with isthmic spondylolisthesis can develop back pain or sciatica as the disc becomes degenerative. Many times this can be treated conservatively with core strengthening, weight loss, activity restriction, and spine injections. If surgery is ultimately needed, there are a variety of treatment options which can be discussed with your surgeon.
This condition occurs when a lumbar vertebra slips out of place. It slides forward, distorting the shape of your spine. This may compress the nerves in the spinal canal. The nerves that exit the foramen (open spaces on the sides of your vertebrae) may also be compressed. These compressed nerves can cause pain and other problems.
Spondylolisthesis has a variety of causes. In children, it is often due to a birth defect in that area of the spine. Some people develop this condition because of an overuse injury called “spondylolysis.” This is a stress fracture of the vertebral bone. In adults, arthritis and the loss of disc elasticity that results from aging are the most common causes of spondylolisthesis.
Less commonly, spondylolisthesis can result from a sudden injury that leads to a broken vertebra. Diseases or tumors that weaken the spine can also result in spondylolisthesis.
Symptoms vary from person to person. Many people who have this condition have no symptoms at all. If you do have symptoms, you may experience pain in your lower back. You may have hamstring spasms. Pain may spread down your leg to your foot. You may also have foot numbness and tingling.
Treatment options depend on the severity of your condition. You may benefit from rest. Medications may relieve your pain. A back brace may also help. And, you may benefit from physical therapy. If those methods are not successful, you may benefit from a surgical procedure to reduce nerve compression or to stabilize your spine.