Spondylolisthesis
A spondylolisthesis or spondy is simply a forward slippage of one vertebra over another. They are graded according to the percent the vertebra has slipped over the vertebra underneath:
Grade I
0-25%
Grade II
25%-50%
Grade III
50-75%
Grade IV
75%+
Causes
In general there are two real causes of spondylolisthesis. The first is a congenital or birth defect in the growth plate of the pars interarticularis. This is the short bone that connects the body of the vertebra with the back part of the spine behind the spinal cord. When the two bones don’t join together as they are supposed to it creates a defect called a spondylolysis. This can sometimes be seen on x-ray, or MRI. When this exists, minor traumas can cause this to area to “fracture” or separate. This then allows one vertebra to slip forward upon another.
The other cause of spondylolisthesis is degenerative in nature. This means that if you don’t take care of your spine, and you develop degenerative disc disease, then undue load is placed on the back of the spine which begins to break down and allows the vertebra to slip forward. This is most commonly seen in the senior population.
Symptoms
I’ve seen patient’s with grade 3-4 spondy’s have little to no symptoms, and I’ve seen patients with grade one spondy’s who are in tremendous pain. The pain can tends to be a deep dull aching in the low back, but if the spondylolisthesis is severe enough it can pinch a nerve as it exits the spine and lead to pain in the buttocks or legs. If this happens in your neck, which is less common unless you’re a football player, you can have pain in your neck and or arms.
Treatment
Unfortunately if you have back pain and a spondylolisthesis, you might be told that the only option is a surgical fusion of the vertebra. If you have a loss of lower extremity control, or loss of bowel and bladder control, then this is likely the step you need to take, even with the high failure rate of fusion surgeries.
If your spondylolisthesis is a grade I to a grade I-II:
Then, there are non-invasive treatments that can be done that strengthen the ligaments and surrounding musculature to stabilize this situation. Often, a spondylolisthesis is accompanied by a disc bulge or facet arthopathies. These situations can often be helped with Non-Surgical Spinal Decompression, Class IV Laser, and our Functional Neurological Orthopedic Rehabilitation (FNOR) procedures to restore function and reduce pain.