Degenerative Spondylolisthesis

Spondylolisthesis is defined as a spinal condition in which one vertebra slips forward over the vertebra below. This “wear and tear” causes deterioration of the vertebra and is known as degenerative spondylolisthesis.

Left untreated, degenerative spondylolisthesis may lead to spinal stenosis.

Causes

  • Most spondylolisthesis is degenerative and is associated with the aging process and wear-and-tear on the spine.
  • Degenerative spondylolisthesis usually occurs in the lumbar (low back) spine, most commonly at L4-L5 (4th and 5th lumbar vertebral levels).
  • However, degenerative spondylolisthesis may occur in other areas as well.
  • Degenerative spondylolisthesis is more common among women, and usually occurs in patients over age 60.

Terminology

  • Spondylolisthesis(when one vertebra slips over the vertebra below) may lead to a narrowing of the spinal canal or spinal stenosis.
  • It is usually degenerative condition and associated with aging and wear and tear.
  • The severity of the condition is expressed in a percentage and categorized by five grades.
    • Grade I the least and grade V the most severe of the condition.

Symptoms

  • Some people with spondylolisthesis are symptom-free and discover the disorder when seeing their doctor for another health problem.
  • In other patients, mild to severe symptoms may occur.

 

  • Typical signs and symptoms include:
  • Low back pain
  • Sciatica
  • Muscle spasms
  • Leg weakness
  • Tight hamstring muscles
  • Irregular gait or limp.

 

Classification of Spondylolisthesis

  • The Meyerding Grading System is used to classify the degree of vertebral damage when making the diagnosis of spondylolisthesis.
  • Slipped vertebra are graded on the basis of the percentage that one vertebral body has slipped forward over the vertebral body below.
  • Grade I: 1-24%
  • Grade II: 25-49%
  • Grade III: 50-74%
  • Grade IV: 75%-99%
  • Grade V: Complete slip (100%), also known as spondyloptosis
  • Treatment will be based on the degree of slip and factors, such as pain and possible neurological symptoms.
  • Most cases of degenerative spondylolisthesis are Grade I or II.
  • In general, the more severe the slip (Grades III and above), the more likely surgical intervention will be recommended.

Treatment

Most cases of degenerative spondylolisthesis are treated without surgery.

Treatments may include:

  • Short-term bed rest
  • Activity restriction
  • Over-the-counter or prescription pain medication
  • Anti-inflammatory medication
  • Muscle relaxants
  • Steroid injections (such as epidural steroid injection)
  • Physical therapy
  • Bracing
  • Degenerative spondylolisthesis can be progressive.
  • This means the spondylolisthesis worsens with time and may cause spinal stenosis.
  • For these reasons, expert care from the Neuro Spinal Hospital is recommended along with regular follow-up to monitor progress.
  • If degenerative spondylolisthesis worsens or causes neurologic problems, such as incontinence, surgery may be recommended.

The Neuro Spinal Hospital team will discuss surgical options with appropriate patients and the aim of this type of procedure is to:

  • Stop the slip from worsening
  • Stabilize the spine
  • Reduce or eliminate symptoms
  • Surgery may involve using instrumentation or bone graft material to help stabilize and secure the spine.
  • They are several different types of surgical procedures that may be used, using different types of instrumentation (rods, screws, pins, and so on) and bone graft products.
  • In some instances, spondylolisthesis surgery may be performed as a minimally invasive procedure with only small incision(s).
  • The Neuro Spinal Hospital Doctors will discuss potential risks and benefits of such surgery with individual patients.

Prognosis

  • Spondylolisthesis is a potentially serious medical problem, which can be safely and effectively treated with expert medical care.

Risk Factors

  • There may be genetic factors involved in spondylolisthesis, so a family history of back problems can be considered a risk factor.
  • Repetitive stress or trauma to the back such as experienced by competitive athletes (such as gymnasts and weight lifters) also presents a risk.

Conclusion

  • Spondylolisthesis, in which one vertebra slips over the next, is a serious condition that may cause pain, limit motion, and lead to spinal stenosis.
  • Spondylolisthesis is typically degenerative, that is, associated with the aging process and wear and tear on the vertebrae
  • Sometimes patients with degenerative spondylolisthesis will develop neurological symptoms.
  • Following accurate diagnosis, there are both conservative (nonsurgical) and surgical treatment options offered by the Neuro Spinal where assistance in helping patients find the most appropriate treatment for their individual case.