Medical Media Images

Lumbar Spondylolisthesis

What does “Lumbar Spondylolisthesis” mean?

The word “Lumbar spondylolisthesis” is a combination of the Greek words “spondylos”, meaning “spine”, and “listhesis” meaning “slippage”.

What is a Lumbar Spondylolisthesis?

One vertebra slips forward or backward on another. This slippage can cause nerve compression at that segment of the spine. Patients with this condition may experience a combination of back pain and leg pain.

Can the spine shift back and forth in a Lumbar Spondylolisthesis?

The condition of a spondylolisthesis can also be divided into those which are stable versus unstable. In an unstable condition, the vertebrae can shift back and forth when the spine moves or with weight-bearing. Patients with an unstable Spondylolisthesis are more likely to have symptoms. Overall only a fraction of the patients who have a Lumbar Spondylolisthesis will be unstable.

What happens when the vertebrae shift in a Lumbar Spondylolisthesis?

When vertebrae shift on each other, several things can happen in the spine:

  1. The discs are stressed since they are attached at the top and bottom sides of the vertebrae which shift. This can cause low-back pain, or even a disc herniation.
  2. The facet joints in the back of the spine can be stressed and pulled apart. This can cause facet joint pain.
  3. The foramen through which the spinal nerve travels often gets smaller in a Lumbar Spondylolisthesis. This can trap the spinal nerve and cause leg pain (sciatica).

What are the different types of Lumbar Spondylolisthesis?

The condition of spondylolisthesis can be divided into three types:

  1. Congenital Spondylolisthesis

These patients will be born with the condition. This condition is also called a “dysplastic spondylolisthesis”. Children are born with a spinal malformation which causes a shift between the vertebrae. This is a rare condition.

       2. Isthmic Spondylolisthesis

This type of spondylolisthesis occurs as a result of a spondylolysis (link) defect. This is the most common form of spondylolisthesis. It occurs in approximately 5-7% of the population.

       3. Degenerative Spondylolisthesis

This type develops as part of an advanced degenerative process of the spine. Typically, the facet joints on the back of the spine become arthritic and form large bone spurs. These bone spurs then begin to push the vertebra forward, causing the shift.

        4. Traumatic

Due to severe spine trauma. Part of the vertebra can be pushed forward due to the force on the spine.

        5. Pathological

Due to a spine cancer which weakens the vertebra.

How is the severity of a Lumbar Spondylolisthesis graded?

The severity of a Spondylolisthesis is determined by the amount of slippage between the vertebrae (Meyerding grading system):

Grade I: The shift is 0-25% of one vertebra on another

Grade II: The shift is 25-50% of one vertebra on another

Grade III: The shift is 50-75% of one vertebra on another

Grade IV: The shift is 75%-100% of one vertebra on another

A slippage of over 100% means that one vertebra is now completely in front of another. This condition has its own name, spondyloptosis.

What are the symptoms from a Lumbar spondylolisthesis?

Here are some of the common symptoms from this condition:

  1. Low back pain and stiffness
  2. Low back spasms
  3. Shooting pain into the legs
  4. Leg numbness and tingling
  5. Leg weakness
  6. A slipping or unstable feeling in the low back
  7. Pain when changing from a sitting to standing position
  8. Pain when bending forward and backward

How is a Lumbar Spondylolisthesis diagnosed?

Spine specialists use information from the patient history, physical examination and special tests to make this diagnosis:

  1. History

Patients often complain about frequent episodes of low-back pain, especially after bending forward and backward. Some patients have feelings of instability in the spine.

      2. Physical Examination

Here are some physical examination techniques used by doctors to diagnose a spondylolisthesis:

  1. Touch and pressure on the spine (palpation)
  2. Testing the spine’s motion (range of motion exam)
  3. Gait testing
  4. Sensation (sensory) testing in the legs
  5. Strength (motor) testing in the legs
  6. Reflex testing in the legs
  7. Straight Leg Raising test (Lesague’s sign)

      3. Imaging

Spine imaging is usually the best way to diagnose a lumbar spondylolisthesis.

a. X-Rays

X-Rays of the spine will show the bone anatomy of the spine. A shift between the vertebrae in a spondylolisthesis can be easily seen on an X-Ray from the side (lateral).

Bending films, where X-Rays are taken with the patient bending forward (flexion) and backward (extension) can show if the spine is unstable and shifts back and forth.

b. CT-Scans

A CT-scan shows bone anatomy in more detail than an X-Ray.

The spondylolisthesis shift can be clearly seen on a CT Scan. However since a X-Ray will show this as well, CT Scans are rarely necessary to make the diagnosis of a spondylolisthesis. The high dose of radiation also has to be taken into account.

c. MRI Scans

MRI scans can show a spondylolisthesis. They are often taken to see what kind of a problem the spondylolisthesis is causing inside the spine. The discs, spinal nerves, spinal cord and cauda equina can all be seen. The compression of the spinal nerve in the foramen can be clearly seen.

d. Nuclear Bone Scans

A nuclear bone scan can show the bone reactivity of a spondylolisthesis. It is usually not necessary to take a bone scan for this condition, since X-Rays and MRI scans will provide all the information needed.

e. Electromyogram/Nerve Conduction Study (EMG/NCS)

EMG/NCS studies can be used to evaluate a compressed spinal nerve in a lumbar spondylolisthesis. The nerve’s function and health can be measured.

What is the treatment for a Lumbar Spondylolisthesis?

1. Non-Surgical Care

Here are some common treatments available for patients not requiring surgery:

A. Alternative Health Care

Alternative Health care options can often complement conventional medical care. Massage Therapy, Acupuncture, Meditation exercises and Herbal Remedies can all help with the pain from this condition. Massage therapy can help with the muscle part of the painful process from a spondylolisthesis.

B. Nutrition and Weight Loss

Proper nutrition and weight loss can have a positive impact on many spine conditions. Excess weight on the spine often contributes to the symptoms of pain and spasms (Spine and Obesity).

C. Chiropractic Care

Chiropractic care including manipulation and adjustments of the spine can help with the pain and spasms from this condition.

D. Spine Exercises

Spine exercises can help with the muscle pain and tightness from this condition. Exercise also increases the amount of oxygen delivered to the spine which can help with healing. Pilates, Yoga and T’ai Chi can help maintain the spine’s flexibility.

E. Physical Therapy (PT)

PT has many modalities to offer for this condition. They can range from Manual Therapy and Exercises to Traction and Ultrasound Treatments. PT usually focuses on core strengthening techniques of the spine. Supporting and conditioning the core muscles of the spine can add stability and improve the symptoms.

F. Self Help Tools

Self Help Tools are items which can be purchased to help with back pain. They range from Back Braces to Back Mattresses and Ergonomic Devices such as chairs and computer accessories. A spinal brace can be very useful in adding stability for patients who have an unstable spine where there is frequent shifting between the Vertebrae.

G. Spine Medications

Here are some of the common groups of medications which are available for this condition:

1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

2. Muscle Relaxants

3. Pain Killers

4. Nerve pain medications

 

H. Injections

Here are some possible spinal injections which can help with the pain from a lumbar spondylolisthesis:

  1. Lumbar Interlaminar Epidural Steroid Injection
  2. Lumbar Transforaminal Epidural Steroid Injection
  3. Lumbar Nerve Root Block
  4. Lumbar Facet Joint Injection
  5. Lumbar Medial Branch Block
  6. Lumbar Facet Joint Radiofrequency Rhizotomy
  7. Caudal Epidural Steroid Injection

 

      2. Surgical Care

Surgery for this condition is usually done for severe back pain or neurological problems from spinal nerve compression. Here are some possible surgical options:

  1. Lumbar Fusion

      2. Lumbar Laminectomy Decompression

      3. Lumbar Laminotomy and Foraminotomy