What is spondylolysis / spondylolisthesis?
Spondylolysis is a defect or fracture of part of the vertebral bone called the pars interarticularis. It usually occurs in the fifth lumbar vertebra and, less commonly, in the fourth lumbar vertebra.
Spondylisthesis is a forward slippage of one vertebral body on top of another.
What causes spondylolysis / spondylolisthesis?
The exact cause of Spondylolysis is unknown, it can be attributed to genetics, overuse activities (particularly those with hyperextension involvement such as gymnastics), and previous surgery.
Spondylolisthesis occurs when there is weakening of the restraining structures of the spine. This can be due to spondylolysis, congenital factors, degeneration of the spine, trauma, and cancer.
What are the symptoms of spondylolysis / spondylolisthesis?
Most people with spondylolysis / spondylolisthesis are asymptomatic and are unaware they have the condition.
When symptoms are present, however, they may include:
- Low back pain
- Feeling of tightness in the back of thighs
- Pain radiating down the legs
- Difficulty with upright posture and gait
Why do patients with spondylolysis / spondylolisthesis have pain?
Patients have pain in the back because of the unstable movement of the vertebra. Leg pain is because of pressure on the nerves.
How are spondylolysis / spondylolisthesis diagnosed?
Usually after a complete history and physical examination your doctor may be able to diagnose a spondylolisthesis. Diagnostic procedures are required to confirm the diagnosis. In some cases the diagnosis may be evident only on investigation. Diagnostic procedures for spondylolysis /spondylolisthesis may include the following:
- X-rays is the initial investigation and provides confirmation of the diagnosis as well as the probable cause. Sometimes special X-rays taken while bending forward and backward may be required for further assessment.
- Magnetic Resonance Imaging (MRI) – MRI scan is an essential part of the investigation for spondylolisthesis as it delineates the nerves and the compression on them.
- Computed tomography scan (also called a CT scan) – A CT scan may be required in specific cases especially in patients operated previously and those with severe degrees of slippage.
What is the treatment for Spondylolysis / spondylolisthesis?
The patient may be treated surgically or non-surgically. Treatment can only be decided after thorough examination and investigations. Every patient will have to be individually evaluated and after considering the extent of the spondylolisthesis / spondylolysis, age of the patient, presence of medical conditions and expectations can a treatment protocol be decided.
What is the non-operative treatment of Spondylolysis / Spondylolisthesis?
Most patients with spondylolysis / spondylolisthesis have acute episodes of pain with intervening pain free periods. These symptoms usually improve with rest and time. To help relieve the pain, treatment may include:
- Analgesics (pain killers)
- Belts/ braces
- Physiotherapy
- Limiting your activities
Patients may also be given a small injection (epidural steroid) into the spine for pain relief.
When is surgery required?
Patients who have one or more of the following symptoms may require surgery.
- Worsening of back pain or persistent leg pain with no improvement even with adequate rest and analgesics
- Weakness of the legs,
- Disturbance of bowel or bladder function
- Progressive forward slipping of the vertebra.
What will be done during the surgery?
The goals of surgery are
- To prevent further slipping of the vertebra
- To relieve the pressure on the spinal nerve
This will require stabilization of the spine with plates and screws as well as decompression of the nerve roots.
What are the types of surgery for spondylolisthesis?
Posterior instrumentation and fusion- Fusion is the surgery by which the two abnormally moving vertebrae are made to join and become a single unit. Instrumentation (stabilization) is the use of metal plates, screws and rods to hold the vertebrae in position till they fuse. Fusion is achieved by placing bone graft over the back of the vertebrae.
Posterior Lumbar Inter-body Fusion (PLIF) - In some patients, additional stabilization of the spine is required. So in addition to posterior instrumentation and fusion, metal cages are placed in between the vertebral bodies to achieve a solid fusion.
Anterior and Posterior surgery- In severe slips, it may be required to operate the patient from the front as well as the back.
What is the post-operative protocol?
In most cases patients will be ready to walk within the first few days of surgery. In more severe degrees of slips, bed rest may be required for a few weeks. Following this a physiotherapist will be there to assist you to start walking and then proceed to spine strengthening exercises. You will be instructed to follow a home program of activity and exercises and asked to come for regular followup.
The surgery for Spondylolisthesis is complex and understanding the altered anatomy and preventing further damage to an already unstable spine requires vast experience and sound decision making. Our institution offers comprehensive treatment for spondylolysis and spondylolisthesis. Due to our vast experience in this condition, we regularly perform the entire spectrum of spondylolisthesis surgery. We also have a fully equipped physiotherapy centre to aid in post-operative rehabilitation.
This information is provided by Ganga hospital and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact the hospital (0422-2485000) to book an appointment to see a doctor. This document was last reviewed on: 1/05/2008
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