What is spondylolisthesis? Besides being a long scientific sounding and difficult to spell name, it is a condition where one vertebra is sliding forward or backward on an adjacent vertebra or the sacrum. “Spondylo” means vertebra, and “olithesis” means to slide on an incline. We see this condition quite often in our office due to that fact that we treat a lot of back pain related conditions. The most common area we see this is in the L4 and L5 vertebrae. (See image below)
Spondylolisthesis can be caused by trauma, congenital defects, pathological (tumors,metastasis) changes, and degenerative changes. Most commonly, spondylolithesis occurs in conjunction with another condition called spondylolysis. Spondylolysis is a stress type fracture of a part of the vertebra called the pars interarticularis. This allows the front part of the vertebra to slide forward. (see below)
What are the symptoms of spondylolithesis? Some people may not have any symptoms, but more often they will have low back pain, leg pain, numbness, tingling, and spasms. In severe causes the patient can have neurological deficits such as incontinence (loss of bowel and bladder control), which becomes a surgical emergency.
Spondylolithesis is graded on the percentage of slippage. Grade I= 0 to 25%; Grade II= 25 to 50%; Grade III= 50 to 75%; Grade IV= 75 to 100% (see below).
Treatment of spondylolisthesis consists of physical therapy and rehab therapy to strengthen and support the low back, manipulation with chiropractic care to take pressure off of the nerves, massage therapy to release spasm and other muscular issues, adjunctive modalities such as trigger point therapy and electric muscle stimulation, as well as anti inflammatory medication and back braces. An integrated approach such as this gives the best results. As mentioned previously, very severe cases, though rare, may require surgery. However, the vast majority of cases can be managed conservatively.