Why does it occur?

Spondylolisthesis is a slipping and malalignment of the bones in the spine called the vertebrae.  The cause of Spondylolisthesis can vary.  Slipping of the vertebrae may occur from a previous fracture (Spondylolysis), arthritis (Spondylosis), deformity of the spine from birth, or trauma.  Sometimes it occurs for no apparent reason.  When these vertebrae bones slide out of proper position, they decrease the size of the canals that your nerves traverse. With a smaller pathway, the nerves become pinched, inflamed, and cause symptoms such as pain, numbness, tingling or even weakness.

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Spondylolisthesis ranges from a small to large percentage of slippage.  Mild deformities (less than 50% overlap) are typically associated with mild to no symptoms while a large percentage slip (greater than 50% overlap) may be associated with severe symptoms and warrant more aggressive care.

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Symptoms:

Symptoms may vary greatly depending on the degree of slippage, chronicity, and associated diagnoses.  Typically patients with a low grade overlap have mild symptoms and sometimes no symptoms at all.  Low grade deformities may even be found incidentally on X-ray.  More significant degrees of slippage and therefore instability crowd the nerves and often lead to more significant symptoms. These symptoms may include pain, muscle spasms, numbness, tingling, shooting pains into the extremities, and even weakness.

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Diagnostic Testing:

An X-ray is usually ordered during your office visit with Dr. Lee.  The X-ray is a valuable tool to assess the bones in your spine and see the degree of vertebral slippage.  Dr. Lee will assess for any mal-alignment, arthritis spur formation, fractures, disc or joint space narrowing, or other bony pathology.  Dr. Lee may also order a CT and/or MRI if your symptoms are significant, failing to improve over time, significant slippage, increasing degree of slippage, or if you have any signs of weakness.

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Treatment Options:

Treatment options will vary depending on the severity of symptoms and associate exam findings. If the Spondylolisthesis is acute, from trauma, or increasing in degree, Dr. Lee may suggest a brace to help stabilize your spine. Physical Therapy may be advised. PT is an important aspect of treatment to strengthen the surrounding musculature of the spine, help alleviate muscle spasms, and decrease pain. Typically heat is applied at the start of the PT visit and ice is applied at the end to ward off inflammation.  NSAIDs such as Advil or Aleve (if not contraindicated) may be advised to reduce inflammation in the area. If your pain is acute and severe, stronger medications may be discussed to address the pain and spasms. Injections may be discussed with patients with severe pain, significant radicular symptoms, or symptoms that did not improve with Physical Therapy, activity modifications, and/or NSAID use.

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Surgical Treatment:

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Surgery may be advised for patients with significant instability or high-grade vertebral slippage.  Surgery may also be advised if the nerve compression becomes severe or if the patient fails to improve with the above non-operative treatments. The majority of patients with Spondylolisthesis, especially those with less than 50% slippage, do not require surgical intervention.

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*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice.  Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.

 

*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.