Spondylolisthesis
Spondylolisthesis is the displacement of vertebral disc from the spinal column. Outward (forward) displacement is termed as anterolisthesis and inward (backward) displacement is termed as retrolisthesis. This condition is often preceded by spondylolysis, a degenerative condition of the vertebra.
Based on the cause of displacement, five subtypes of spondylolisthesis are identified, they are:
- Dysplastic spondylolisthesis
- Isthmic spondylolisthesis
- Degenerative spondylolisthesis
- Traumatic spondylolisthesis
- Pathologic spondylolisthesis
Among the various subtypes of spondylolisthesis, the two most common forms commonly observed are dysplastic spondylolisthesis and isthmic spondylolisthesis
- Dysplastic spondylolisthesis: This subtype is a congenital condition, present at birth, and is caused because of abnormal bone formation of the facet part of the vertebra resulting in spondylolisthesis.
- Isthmic spondylolisthesis: This type of spondylolisthesis occurs because of a defect in the pars interarticularis part of the vertebra. This is more common in athletes and gymnasts as they often suffer from overuse injuries.
Signs and symptoms that suggest spondylolisthesis in patients include:
- Lower back pain
- Stiffness in the back and tightening of the hamstring muscles from spasms
- Pain in the thighs and buttocks
- Decreased range of motion of the lower back
- Pain and weakness of the legs or numbness because of nerve compression
- Loss of control on bowel or bladder function by severe nerve compression
- Increase in lordosis curve, also called swayback
- Kyphosis (round back)
The cause for spondylolisthesis is multifactorial; the common causes are overuse injuries of spine, congenital abnormalities, trauma, bone disorders and fractures.
Treatment for spondylolisthesis is based on the diagnosis made by collecting medical & family history, a physical examination, and radiographic scans. During the diagnosis, the severity of displacement is also assessed which is expressed as grade I to IV. In mild conditions and for symptomatic relief, conservative treatments including medications, bracing and physical therapy are recommended. In severe cases, surgical correction with decompression laminectomy followed by spinal fusion is recommended. The procedure involves removal of a portion of vertebra compressing the nerves and other vertebra followed by removal of disc between the vertebrae and fusion of adjacent vertebrae. Fusion surgery is performed to confer stability to the spine. Following the surgery, your surgeon recommends physical therapy and rehabilitation programs to regain strength to the surrounding bones & muscles as well as to make you active soon.
