What is Spondylolisthesis?

Spondylolisthesis is a spinal condition where one vertebra (a bone in the spine) slips forward in relation to the one below it.

Normally, the bones in the spine are arranged in a stacked formation like building blocks, and they are secured in place by the bony joints, discs, ligaments, and the shape of the bones.

Forward displacement is called anterolisthesis and backwards is termed retrolisthesis.

Spondylolysis is a spinal condition that occurs when a fracture or defect develops in one of the vertebrae in the spine, most commonly in the lower back (lumbar spine). When the defect leads to shifting out of position, it is termed spondylolisthesis.

What causes spondylolisthesis?

There are several factors that can lead to spondylolisthesis:

  1. Dysplastic spondylolisthesis: Secondary to congenital abnormalities.
  2. Isthmic/ Lytic spondylolisthesis: Gaps in the bone or deformed parts of the bone.
  3. Degenerative spondylolisthesis: Wear and tear.
  4. Traumatic spondylolisthesis: Injury like a motor vehicular accident.
  5. Pathological: Infection or tumour.

How does spondylolisthesis present?

The signs and symptoms of spondylolisthesis can vary depending on the severity of the condition. Some people with spondylolisthesis may not experience any symptoms, and the commonest way it is diagnosed is by scans and x-rays.

Other symptoms may include:

  • Back pain: This is the most common symptom of spondylolisthesis, ranging from mild to severe.
  • Stiffness: People with spondylolisthesis may experience stiffness in the back, especially when getting up from a seated or lying position.
  • Nerve compression: If the slipping vertebra compresses a nerve, it can cause numbness, tingling, or weakness in the legs or feet.
  • Muscle tightness: People with spondylolisthesis may experience tightness in the hamstrings or lower back muscles.

How is spondylolisthesis treated?

The treatment for spondylolisthesis depends on the severity of the condition and the symptoms it causes.

In some cases, no treatment may be necessary; in others, a combination of treatments may be recommended.

Some common treatment options for spondylolisthesis:

  1. Conservative treatments: This may include rest, physical therapy, pain medication, and wearing a back brace to support the spine.
  2. Lifestyle modifications: Certain lifestyle modifications, such as maintaining a healthy weight, practising good posture, and avoiding activities that place excessive stress on the spine, can help prevent the condition from worsening.
  3. Steroid injections: If the pain is severe, steroid injections may be given directly into the affected area to reduce inflammation and pain.
  4. Surgery: In more severe cases of spondylolisthesis, surgery may be necessary to realign the vertebrae and relieve pressure on the nerves.

The appropriate surgical procedure is based on your individual condition. The risks, benefits, and post-operative care will vary depending on the type of surgery required.

A decompression surgery is a relatively simple procedure that can relieve pressure on nerve roots and has good success rates in relieving leg pain, but it may not always be the sole treatment option.

A posterolateral fusion with a decompression surgery is a more involved procedure that involves relieving pressure on nerve roots and fusing part of the spine through an incision on your back. The procedure involves placing rods and screws in your spine to help reduce the amount of slippage and prevent it from worsening. A strut (cage) may also be used in the disc space in the spine (such as PLIF, TLIF, LIF, and ALIF).

An anterior and posterior instrumented correction surgery involves an operation on the front or side of the spine (through an incision on your abdomen) followed by an operation on the back of the spine with rods and screws. This is a major operation that is used to realign your spine, especially in cases of severe spondylolisthesis.

Explore more related spinal conditions:

Spinal Deformity: Explore the different types of spinal deformities and their potential causes and effects.
Paediatric Scoliosis: Learn about the abnormal curvature in children's spines and its potential treatment options.