Spondylolisthesis

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Your spine, or backbone, is your body’s central support structure. It connects different parts of your musculoskeletal system. Your spine helps you sit, stand, walk, twist, and bend. Back injuries, spinal cord conditions, and other problems can damage the spine and cause back pain.

Spondylolisthesis is a condition that involves spine instability, which means the vertebrae move more than they normally should, e.g. a vertebra slips out of place onto the vertebra below. It may put pressure on a nerve, which could cause lower back pain or leg pain. There is another condition known as spondylolysis, however, both spondylolysis and spondylolisthesis are not related, as described below:

 

  • Spondylolysis – This spine defect is a stress fracture or cracks in the spine bones. It is common in younger athletes who participate in sports such as basketball and football.

 

  • Spondylolisthesis – This condition is when a vertebra slips out of place, resting on the bone below it. Spondylolysis may cause spondylolisthesis when a stress fracture causes the slipping, or the vertebra may slip out of place due to a degenerative condition. The disks between the vertebrae and the facet joints can also wear down. The bone of the facet joints actually grows back and overgrows, causing an uneven and unstable surface area, which makes the vertebrae less able to stay in place. No matter what the cause, when the vertebra slips out of place, it puts pressure on the bone below it. Spondylolisthesis contains a total of six different types of the same condition, such as the following:

 

Congenital spondylolisthesis

This condition is a form of spondylolisthesis, a spine condition that results when one of the vertebrae slips forward (also known as anterolisthesis) or backward (retrolisthesis) when compared to the vertebrae adjacent to it. Congenital spondylolisthesis, also called dysplastic spondylolisthesis, indicates the condition is present at birth.

 

Isthmic spondylolisthesis

This is a spinal condition in which one vertebra slips forward over the vertebra below. It is caused by a defect, fracture, of the pars interarticularis (a bone connecting the upper and lower facet joints). The defect may be congenital, and a fracture can be caused by the accumulative affecting of spinal stress. Sometimes isthmic spondylolisthesis affects young athletes as well.

 

Degenerative spondylolisthesis

As people age, general wear and tear cause changes in the spine. Intervertebral disks begin to dry out and weaken. They lose height, become stiff, and begin to bulge. This disk degeneration is the beginning of both arthritis and degenerative spondylolisthesis (DS). As arthritis develops, it weakens the joints and ligaments that hold your vertebrae in the proper position. The ligament along the back of your spine may begin to buckle. One of the vertebrae on either side of a worn, flattened disk can loosen and move forward over the vertebra below it. The slippage can narrow the spinal canal and put pressure on the spinal cord. This narrowing of the spinal canal is called spinal stenosis and is a common issue in patients living with degenerative spondylolisthesis.

 

The other three less common types of spondylolisthesis include:

 

  • Pathological spondylolisthesis – this happens when a disease, such as osteoporosis or tumor, causes the condition to develop.

 

  • Traumatic spondylolisthesis – occurs when an injury causes vertebrae to slip.

 

  • Post-surgical spondylolisthesis – is the slippage as a result of spinal surgery.

Causes & Symptoms of Spondylolisthesis

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The progression of spondylolisthesis begins with the lumbar spine exposing to directional pressures while it carries, absorbs, and distributes most of your body’s weight at rest and during activity. In other words, while your lumbar spine is carrying and absorbing body weight, it also moves in different directions (rotate and bend forwards). Sometimes, this combination causes excessive stress to the vertebra and / or its supporting structures and may lead to a vertebral body slipping forward over the vertebrae beneath.

Typically, you may not experience any symptoms of spondylolisthesis. In fact, some people have the condition and don’t even realize it. However, if you do have symptoms, lower back pain is usually the primary symptom. The pain may extend to the buttocks and down the thighs. You may also experience:

 

  • Muscle spasms located in the hamstrings (muscles in the back of the thighs).

 

  • Lower back stiffness.

 

  • Difficulty when walking or standing for a long period of time.

 

  • Sudden pain when bending over.

 

  • Numbness, weakness, or tingling in the foot.

Who gets Spondylolisthesis?

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Certain risk factors of spondylolisthesis include the following:

 

Genetics

Some patients with isthmic spondylolisthesis are born with a thinner section of the vertebra called the pars interarticularis. This thin piece of bone connects the facet joints, which link the vertebrae directly above and below to form a working unit that permits movement of the spine. These thinner areas of vertebrae are more likely to fracture and slip. Degenerative spondylolisthesis also has a large genetic component.

 

Sports

Young athletes (either children or teens) who participate in sports that stretch the lumbar spine, such as gymnastics and football, are at higher risk of developing spondylolisthesis. The vertebra slippage tends to occur during children’s growth spurts. Spondylolisthesis is one of the most common reasons for back pain in teens.

 

Age

As individuals age, degenerative spine conditions can develop, which is when wear and tear on the spine weaken the vertebrae. Elders with degenerative spinal conditions may be at higher risk for spondylolisthesis. It becomes more common after the age of 50.

How Does it Affect You? How Serious is it?

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Serious spondylolisthesis can sometimes lead to another condition called cauda equina syndrome. Cauda equina syndrome is a rare but serious condition that describes extreme pressure and swelling of the nerves at the end of the spinal cord. If patients with cauda equina syndrome do not receive further treatment rapidly, adverse results can include paralysis, impaired bladder, and / or bowel control, difficulty walking, and other neurological and physical problems.

Symptoms of cauda equina syndrome can develop suddenly, although it may take weeks or months. The onset of the condition is often described using the following distinctions:

 

Acute onset

This is marked by a rapid development of symptoms that often includes severe low back pain and significant loss of bladder and bowel function. In an acute onset, sensory and motor deficits in the lower body typically develop within 24 hours.

 

Gradual onset

This can develop over progressively, and symptoms may come and go over the course of several weeks or months. Gradual onset normally includes partial or intermittent loss of bowel and bladder function, as well as recurring low back pain in combination with muscle weakness, numbness, bladder, bowel incontinence, and / or dysfunction.

Recommended Treatment & Rehabilitation

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During a diagnosis of spondylolisthesis, a healthcare provider will perform a physical exam and ask you about your symptoms. You will then likely need an imaging scan to confirm the diagnosis. Some of these tests include:

  • X-rays – X-rays are useful in showing if the lumbar bone has slipped forward and the extent of the slippage. This diagnostic test may also show if any abnormalities due to advancing age are present within the spine, such as the formation of bone spurs.
  • Magnetic Resonance Imaging (MRI) scan – An MRI is a more detailed scan that uses radio waves and a magnetic field to generate thorough images of interior bones and soft tissues. An MRI scan can take a clearer image of the prolapsed disc and identify any compression in the spinal cord.
  • Computed Tomography (CT) scan – A CT scan takes a series of X-ray images from several different angles, which are then merged to create cross-sectional images of bones and soft tissues with the body. This allows your physician to examine the spinal column and its surrounding structures.
  • Electromyography (EMG) – An EMG shows the electrical activity of a muscle during rest and when they contract. Examining the electrical activities may help your physician observe any nerve damage, which along with other diagnostic tests, may provide very useful information about the condition.
  • Nerve Conduction Velocity (NCV) – NCV shows the speed at which electrical signals move through a nerve. Slow nerve signal speed may indicate nerve damage.

In addition, your doctor may give you a grade based on how severe the spondylolisthesis is…low-grade (1 or 2) is less serious and typically does not require surgery; high-grade (3 and 4) is more serious. You may need surgery, especially if you are in a lot of pain.

After a diagnosis has been done, physiotherapy may be performed. A physiotherapist will design a targeted treatment program based on your condition. It will be created to safely return you to sports or daily activities. The following physiotherapy treatment plans may include:

 

Patient education

Your physiotherapist will work with you to identify and change any external factors causing your pain. These factors can include the type and amount of exercise you do, your athletic activities, footwear, or the surfaces on which you practice and play. Your therapist may also recommend changes in your daily activities.

Pain management

Your physiotherapist will design a program to address your pain. This may include applying ice to the affected area. Applying heat is also helpful in some cases. Electrical stimulation gently targets nerve fibers that send pain signals to the brain. It also may be used together with ice to help relieve your pain. Your physiotherapist also may recommend decreasing some activities that cause pain.

Body mechanics

How you move and use your body for work and other activities can contribute to lumbar spine problems and pain. Your physiotherapist will teach you how to improve your movements or body mechanics based on your daily activities. He or she may also make recommendations to improve the way you do certain activities, such as lifting and carrying objects.

Manual therapy

Manual therapy for lumbar stress fracture and slipped vertebra includes “soft tissue release” or massage for tight and sore muscle groups. These hands-on techniques may be used to correct the tightness of muscles to promote normal movement.

Functional training

Once your pain, strength, and motion improve, you will need to safely move back into more demanding activities. To lessen your risk of repeated injury, it is important to learn safe, controlled movements. Based on your unique movement assessment and goals, your physiotherapist will create a series of activities to help you use and move your body more correctly and safely for years to come.

To improve your spondylolisthesis symptoms, focus on strengthening your core, hip, and back muscles with these exercises. Here are some exercise examples for you to try:

 

Cat cow pose

This specific yoga pose offers gentle stretching to warm you up. Firstly, get on your hands and knees on a mat. While breathing, arch your back and extend your neck while raising your gaze to the ceiling. Hold for 10 seconds, then bring your head down and your chin toward your chest while simultaneously bringing your abdomen up and rounding your back like a cat stretching. Lastly, hold for 10 seconds, then repeat these movements 10 more times a day.

 

Lower back release

Lie on your back with knees bent and feet flat on the floor. Contract your abdominal muscles to pull the navel toward the spine and flatten the lower back to the floor. Hold for 5-10 seconds, then release before repeating 20 times a day.

 

Lumbar extension

Stand with your feet together and bring your hands together over your head. Gently reach your hands backward while arching your back without causing pain. Hold for one minute, then slowly stand upright and bring your hands to your sides. It is recommended to repeat this exercise 10 times a day.

 

Bridge exercise

Lie on the floor with your knees bent and feet flat on the floor. Position your arms at your sides, with palms down. As you exhale, raise your hips off the floor and push them toward the ceiling to create a slope from your knees to your chest. While continuing to breathe, hold the pose for up to 30 seconds, then return to the starting position, repeating 10 times a day.

Alternative & Homeopathic Treatment

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Choices of spondylolisthesis treatments depend on what is causing your symptoms, the location of the problem, and the severity of your symptoms. If your symptoms are mild, your healthcare provider may recommend some homeopathic treatments first. Here are some home remedies you can try:

  • Heat application – Heat typically is the better choice for pain due to spinal injuries in general. Heat increases blood flow, which relaxes muscles and relieves aching joints.

 

  • Ice application – If heat is not relieving your symptoms, try an ice pack or frozen gel pack. Usually, ice is applied 20 minutes on and 20 minutes off. Ice reduces swelling, tenderness, and inflammation.

 

  • Pain relievers – Pain medications such as ibuprofen, naproxen, and acetaminophen may be used temporarily to ease the discomfort of spondylolisthesis.