Lumbar Spondylolisthesis Overview
Spondylolisthesis occurs when one vertebra slips forward in relation to adjacent vertebrae. Many of our patients with this condition can suffer from back pain, leg pain, buttocks pain and other associated symptoms.
The term ‘spondylolisthesis’ is composed of two Greek words. ‘Spondylo’ means vertebrae. ‘Olisthesis’ means to slide on an incline. Degenerative spondylolisthesis is most common in the lumbar spine. More specifically in L4-L5.
Symptoms
The usual symptoms for lumbar spondylolisthesis are low back pain, muscle spasms, thigh or leg pain, and physical weakness. Interestingly, some patients do not show any symptoms. The confirmation of the spine condition is only done after the spinal radiographs.
The pain in lower back caused by spondylolisthesis is usually treated using non-surgical methods. Bed rest for a few days is recommended during the acute pain phase. Any activities which may involve heavy lifting are forbidden to prevent the stress to the lower back.
The patients might complain of pain in the leg, in addition to the back pain. Leg pain is typically caused by narrowing of the area where the nerves leave the spinal canal. This effect produces irritation and inflammation of a nerve root in the collection of nerves in the lumbar spine. This bundle of nerves is called cauda equina.
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Diagnosis
Spondylolisthesis is usually diagnosed using various tests, such as an X-ray, CT scan or MRI scan. The physician confirms diagnosis of spondylolisthesis by noting the forward position of one vertebral body on another. The physician may also look for possible bone fractures on X-ray scans.
Non-Surgical Treatment
If the patients do not have signs of significant nerve compression or neurological impairment, then the physicians recommend non-surgical treatment. This includes medication, rest and physical therapy. Bracing is also a consideration, along with epidural steroid injections. Oral steroids could be administered to reduce inflammation in the area.
Surgical Treatment
Spine surgery is usually only considered if the conservative therapies have failed to adequately relieve the symptoms.
Following surgical procedures may be considered for treatment of lumbar spondylolisthesis;
- Spinal decompression or laminectomy. In this procedure, the bone along with offending ligamentum flavum is removed. Hence, the compression on the nerves is relieved.
- Spinal fusion. In this procedure, the bone graft along with instrumentation is placed between vertebrae. This is done to make the vertebrae fuse together.
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