What is spondylolisthesis?
This is when a bone in the spine (vertebra) slips forwards on another. Usually all the bones in the spine line up like building blocks and are held there by the bony joints, discs, ligaments and the shape of the bones.
If one of these structures fail for whatever reason, it allows the bone to move forwards and out of position, resulting in a step.
Disorders affecting the spine can cause the spondylolisthesis (forward slippage). Some causes include:
- Wear and tear (degenerative)
- Gaps in the bone or deformed parts of the bone (isthmic or lytic)
- Infection or tumour affecting the bone (pathological)
- Abnormally shaped bones from birth (congenital)
- Injury such as a road traffic accident (traumatic)
The severity of a spondylolisthesis is decided by the amount the bone has slipped forwards.
How would I know I had spondylolisthesis?
The commonest way a spondylolisthesis is identified is by scans and X-rays.
You may notice:
- Pain, pins and needles, numbness or weakness due to pressure on nerve roots (running down the legs or arms)
- Difficult walking due to pain or a feeling of clumsiness
- A change in the shape of your back with flattening of the waist and your bottom sticking out (not common)
Why does it matter?
Spondylolisthesis may go on to cause pain in the back. It may result in pressure on the nerve roots and this can cause pain, pins and needles, numbness and or weakness in the limbs.
It is usually these issues that need the treatment rather than the spondylolisthesis itself.
In children, if the slippage worsens, then treatment may be suggested to try and prevent future problems.
What should I do if I think I have a spondylolisthesis?
Speak to your GP. Your GP will be able to examine you. Sometimes your GP may order tests (such as an MRI scan) that shows a spondylolisthesis.
If your GP is concerned, they will refer you to a Spine Surgeon at a hospital for further tests.
If you have no pain, you can usually carry on with your normal activities, including sports. If you have pain, it might be better to stop sports until you are seen.
How will the doctors check if I have a spondylolisthesis?
The first thing the GP or specialist will do is talk to you about your concerns. They will ask you questions about your health generally, how the problems are affecting you and try to get an idea how much more growth and development you have if you are not fully grown yet.
The doctors will want to examine you. They will need to examine your back, your ams and your legs, so you will need to get undressed for this. Often the hospital will give you a gown, but wearing shorts and a T shirt or sports bra may make you feel more comfortable. The examination will look at your back and see how flexible it is. They will look at your back. Your arms and or legs will be examined to make sure the spinal cord and nerve roots are working normally.
The Spine Surgeon will send you for further tests. This is most commonly an MRI scan, but could be an X - ray or a CT scan.
In younger children, a spondylolisthesis may be monitored with repeat X - rays.
How can you treat a spondylolisthesis?
The spondylolisthesis is treated if there are pain or nerve symptoms related to it. In a child an increased amount of slippage of the bones may need treatment.
The commonest initial treatment is pain killers. Often the GP will start these. They may be for the back pain and or the nerve root pain. Examples of pain killers used are paracetamol, codeine, amitriptylline or gabapentin. If this is enough to help your symptoms, it may be that no further treatment is required.
Although physiotherapy doesn't cure the spondylolisthesis or the cause, it can help the pain. It is therefore worth trying. Physiotherapists may try acupuncture and other methods as well as exercises.
Braces are rarely used in adults with spondylolisthesis. They may be used in some children . Your specialist will explain the brace and its uses if it seems an appropriate treatment for you after assessment.
Injections are a common way of treating the pain from a spondylolisthesis, especially in adults. They may help control the pain enough to keep you functional. They can be into the joints in your back or around the nerve roots. The injections use a combination of steroids and local anaesthetic. They can be repeated if necessary. The main down side for injections is that they don't work for everyone and if they do work they can wear off. The upside of injections is that they are low risk and relatively easy to have done.
Surgery in spondylolisthesis varies according to the symptoms that are being caused and the amount of slippage.
The exact operation will be decided with your specialist. The risks and advantages as well as the post operative care will depend on the type of surgery required.
A decompression is a relatively small and straightforward operation to relieve pressure on nerve roots. It is not always possible to be used in isolation, but when it is it usually has good success rates for relieving leg pain in particular.
A posterolateral fusion with a decompression is an operation that relieves pressure on nerve roots as well as fuses part of the spine through a cut on your back. It involves rods and screws being placed in your spine. The rods and screws help reduce the amount of slippage and help stop it worsening. The rods and screws may be supplemented with a strut (cage) in the disc space in the spine (PLIF, TLIF, LIF, ALIF).
An anterior and posterior instrumented correction involves an operation on the front or side of the spine (through a cut on your tummy) first and then an operation on the back of the spine with rods and screws. It is a big operation to realign your spine especially when you have a severe spondylolisthesis.