Spinal Conditions – Degenerative Spondylolisthesis

Spondylolisthesis is a spinal condition in which one vertebra slips forward over the vertebra below. When it is caused by deterioration or “wear and tear” of the vertebrae, it is known as degenerative spondylolisthesis. Left untreated, degenerative spondylolisthesis may lead to spinal stenosis.
 
Causes
 
Most spondylolisthesis is degenerative, that is, associated with the aging process and wear-and-tear on the spine. Degenerative spondylolisthesis usually occurs in the lumbar (low back) spine, most commonly at L4-L5 (4th and 5th lumbar vertebral levels). However, degenerative spondylolisthesis may occur in other areas as well.
 
Degenerative spondylolisthesis is more common among women, and usually occurs in patients over age 60.
 
Terminology
 
Spondylolisthesis (slippage of one vertebra over the other) may lead to a narrowing of the spinal canal or spinal stenosis. It is usually degenerative, that is, associated with aging and wear and tear. The severity of the condition is expressed in a percentage and categorized by five grades, with grade I the least and grade V the most severe.
Symptoms
 
Some people with spondylolisthesis are symptom-free and discover the disorder when seeing their doctor for another health problem. In other patients, mild to severe symptoms may occur. Typical symptoms may include:
  • Low back pain
  • Sciatica
  • Muscle spasms
  • Leg weakness
  • Tight hamstring muscles
  • Irregular gait or limp
Classification of Spondylolisthesis 
 
Doctors use the Meyerding Grading System to classify the degree of vertebral slippage in spondylolisthesis. This system is easy to understand. Slips are graded on the basis of the percentage that one vertebral body has slipped forward over the vertebral body below.
 
  1.     Grade I: 1-24%
  2.     Grade II: 25-49%
  3.     Grade III: 50-74%
  4.     Grade IV: 75%-99%
  5.     Grade V: Complete slip (100%), also known as spondyloptosis
 
Treatment will be based on the degree of slip and factors, such as pain and possible neurological symptoms. Most cases of degenerative spondylolisthesis are Grade I or II. In general, the more severe the slip (Grades III and above), the more likely surgical intervention will be recommended.
 
Treatment
 
Most cases of degenerative spondylolisthesis are treated without surgery. Treatments may include:
 
  •     Short-term bed rest
  •     Activity restriction
  •     Over-the-counter or prescription pain medication
  •     Anti-inflammatory medication
  •     Muscle relaxants
  •     Steroid injections (such as epidural steroid injection)
  •     Physical therapy
  •     Bracing
 
Degenerative spondylolisthesis can be progressive. This means the spondylolisthesis worsens with time and may cause spinal stenosis. For these reasons, expert care from the Neuro Spinal Hospital is recommended along with regular follow-up to monitor progress.

If degenerative spondylolisthesis worsens or causes neurologic problems, such as incontinence, surgery may be recommended. The goals of surgery are to:

 
  •     Stop the slip from worsening
  •     Stabilize the spine
  •     Reduce or eliminate symptoms
 
Surgery may involve using instrumentation or bone graft material to help stabilize and secure the spine. They are several different types of surgical procedures that may be used, using different types of instrumentation (rods, screws, pins, and so on) and bone graft products. The Neuro Spinal Hospital team will discuss surgical options with appropriate patients.
 
In some instances, spondylolisthesis surgery may be performed as a minimally invasive procedure with only small incision(s). The Neuro Spinal Hospital will discuss potential risks and benefits of such surgery with individual patients.
 
Prognosis
 
Spondylolisthesis is a potentially serious medical problem, which can be safely and effectively treated with expert medical care.
 
Risk Factors
 
There may be genetic factors involved in spondylolisthesis, so a family history of back problems can be considered a risk factor. Repetitive stress or trauma to the back such as experienced by competitive athletes (such as gymnasts and weight lifters) also present a risk.
 
Conclusion
 
Spondylolisthesis, in which one vertebra slips over the next, is a serious condition that may cause pain, limit motion, and lead to spinal stenosis. Spondylolisthesis is typically degenerative, that is, associated with the aging process and wear and tear on the vertebrae. Sometimes patients with degenerative spondylolisthesis will develop neurological symptoms. Following accurate diagnosis, there are both conservative (nonsurgical) and surgical treatment options. The Neuro Spinal Hospital can assist in helping patients find the most appropriate treatment for their individual case.