Spondylolisthesis

Overview of Spondylolisthesis in India

Spondylolisthesis is where one of your back bones (spine vertebrae) slips forward out of position on top of the next lower spine bone, resulting in an inflamed and painful area at the site of this displacement.

It most often occurs in the lumbar region (lower back) causing lower back pain. Spondylolisthesis can either be congenital (present at birth), isthmic (this results from fractures of the bone), or degenerative (due to injury or age).

What Is Spondylolisthesis?

Spondylolisthesis is what happens when one of the vertebrae in your spine kind of slips out of its spot, and then it puts a bit of pressure on the vertebra right below it. People usually say spondylolisthesis kind of like, spohn-di-low-less-THEE-sis, so don’t worry if you’re not 100% on it the first time.

Your spine is built from 33 stacked bones called vertebrae, which is the plural form of vertebra. These vertebrae are connected and they can move a little when you shift your body, stretch, or change posture.

With spondylolisthesis, one vertebra moves more than it normally should, and slides out of its usual position onto the vertebra underneath it. That shift can squeeze or irritate nerves near your spine, which may lead to back pain and other related issues.

This condition can show up anywhere along your spine, but it’s especially common in the lower back, the lumbar spine area. It can also affect your neck, that’s the cervical spine, or your midback which runs from the bottom of your neck to just below your ribs, the thoracic spine.

Think of your vertebrae like links in a chain that are constantly there to support you. It can sound alarming to imagine one link moving out of alignment, but that doesn’t automatically mean the whole chain is failing or going off track. Spondylolisthesis often responds really well to treatment.

If you notice new pain in your back, in your legs, or anywhere else that makes it tough to get through your day, it’s a good idea to check in with a healthcare provider.

Types of Spondylolisthesis:

There are many different types of spondylolisthesis including:

Degenerative spondylolisthesis: This is the most common type and occurs due to natural aging and wear on the disks that cushion the vertebrae and as these disks wear away there is more space between the vertebrae increasing your chances of one vertebra slipping out of place.

The treatment one requires depends on the degree of severity of Spondylolisthesis. 

Grade I: There is between 0 and 25% slippage.

Grade II: There is between 26 and 50% slippage.

Grade III: There is between 51 and 75% slippage.

Grade IV: There is between 76 and 100% slippage.

Grade V: There is over 100% slippage.

Congenital spondylolisthesis (dysplastic spondylolisthesis): This type occurs in infants when the vertebrae do not grow correctly prior to being born. The misaligned vertebrae may cause problems at birth or later in life.

Isthmic Spondylolisthesis: This occurs when the pars interarticularis, the bone that connects the two vertebrae, breaks and the fractured vertebra cannot hold its normal position causing it to slip out of place.

Less common spondylolisthesis types include:

Traumatic spondylolisthesis: Any injury or trauma that is strong enough to displace a bone in the spine will lead to a spondylolisthesis.

Pathologic spondylolisthesis: If the vertebrae are weak from illness or disease (osteoporosis or tumor), they are more likely to slip out of place.

Postsurgical spondylolisthesis: Though rare, a spondylolisthesis caused by the surgical manipulation of the spine can occur as one of the complications from that procedure.

Procedure:

In most situations, non surgical treatment like physical therapy and bracing can help ease pain , and also boost function. Below are a few non surgical options to treat spondylolisthesis, kind of in that sense.

Activity modification and bracing

If any movement makes the pain worse, it is usually advised to take a break until the discomfort settles back down. Doctors may also ask you to wear a back brace, to support the lower back and stop the spine from forming odd or unusual curves.

Physical Therapy

Physical therapy may lower lower back pain. Stretching the muscles that help hold up the spine can also reduce soreness and ease tension on the lower back.

Pain Relief Medication

Doctors might recommend over the counter nonsteroidal anti inflammatory drugs, or NSAIDs, to cut down inflammation in the spine and nearby tissues. Some of the most common NSAIDs are ibuprofen , naproxen, and aspirin.

Corticosteroid Injection

A corticosteroid injection puts anti inflammatory medicine straight into the spine area. Usually, this injection is suggested only if the other non surgical treatments did not bring much relief.

In fewer cases, when a person with spondylolisthesis does not improve with non surgical care, surgery becomes necessary to calm the pain and help keep the condition from moving forward or advancing. The surgical treatments include :

Pars Repair

Here, the broken part of the vertebra is stabilised using wires or screws, joining the sides of the fractured bone and aligning the vertebra. If the fractured bone is very fragile and needs reinforcement, tissue taken from another area of the body may be used to help the affected bone heal.

Spinal Decompression

With this approach, the pressure on the nerves is relieved, which tends to reduce pain and improve how the spine works. There are three types of spinal decompression.