What Is Spondylolisthesis?
Your spine consists of 26 bones stacked up upon each other creating your vertebrae. There can be many spine conditions in which these bones or discs become damaged including herniated discs, spinal stenosis, spinal curving disorders like kyphosis, osteoporosis, etc. In addition to those mentioned, spondylolisthesis could be the culprit causing the pain you are experiencing in your back.
Spondylolisthesis definition is when one of your bones in your vertebra slides forward (also called anterolisthesis) or backward (also called retrolisthesis) over the bone next to it. This typically occurs at the fifth or fourth vertebra of the low back, with slippage of the fifth vertebra (L5) being the most common form of lumbar spondylolisthesis. Cervical spondylolisthesis of the upper neck area of the spine is much more rare, though it does occur. This slippage of your vertebra presses down on the nerves in your spine, which ultimately causes the pain and discomfort.
Spondylolisthesis can affect individuals of all ages. Teens and children involved in high contact sports such as weightlifting, gymnastics, or football are more prone to spondylolisthesis due to the overuse of their spine and back muscles. In addition, older individuals are also more prone to spondylolisthesis because of the degeneration in their joints, bones, and tissues.
What Are Common Symptoms of Spondylolisthesis?
For some individuals, there may be no symptoms of this condition. Spinal spondylolisthesis symptoms can arise over a few years and may not appear immediately. But for some, you may experience all or some of the symptoms below:
- Lower back pain (most common symptom)
- Muscle spasms
- Stiffness or tightness in your back or hamstring
- Pain, tingling, numbness, or weakness in your legs, buttocks, lower back, or hips
- Pain that radiates down both or one of your legs
- Limping or difficulty walking
- Loss of control over your bladder or bowel movements (rare symptom)
Not experiencing any of the symptoms above? You may have a different back injury or condition!
How Is Spondylolisthesis Diagnosed? What is the Grading Scale for Spondylolisthesis of the Back?
The easiest way for your doctor to diagnose your condition is looking at X-rays in your back to see if any of the bones in your vertebrae have slipped forward or cracked. In addition, they may order a CT scan or an MRI to help figure out how severe or mild your condition may be.
The grade of your condition is based on the distance from the posterior edge of the superior body of the vertebrae to the same edge of the inferior vertebral body. This is divided into five different levels:
Grade I: Slip is up to 25%
Grade II: Slip is between 26%-50%
Grade III: Slip is between 51%-75%
Grade IV: Slip is between 76%-100%
Grade V: Your vertebrae has completely fallen off the next vertebra (also called spondyloptosis and is a very rare condition)
What Type of Spondylolisthesis Do I Have?
There are five (six if you count postsurgical) major types of spinal spondylolisthesis, including:
- Isthmic (spondylolytic) spondylolisthesis: Defect in our pars interarticularis (a portion of your vertebra). This can be caused by repetitive trauma or fall to the spine causing breaks and stress fractures in your vertebrae.
- Degenerative spondylolisthesis: This is the most common type of spondylolisthesis. The result of the aging process in which your joints degenerate or become weak, allowing your vertebrae to slip forward or backward.
- Traumatic spondylolisthesis: Result of trauma or injury to your spine in which your joints allow your vertebra to slip forward or backward.
- Pathologic spondylolisthesis: Result of a disease such as infection, tumor, cancer, etc.
- Dysplastic (congenital) spondylolisthesis: This is a result of a birth defect causing your facet (part of your vertebra) to slip forward.
What’s the Difference Between Spondylolysis and Spondylolisthesis?
Spondylolysis vs. spondylolisthesis—what’s the difference, you’re likely asking. Spondylolysis is when there is a separation of the pars interarticularis, which is the small bony arch towards the back of your spine. Spondylolysis refers to stress fractures to the bones of the spine. This can cause the bones to weaken to such an extent that one shifts out of place. When this happens, the progression from spondylosis to spondylolisthesis occurs.
To break this down even further, isthmic spondylolisthesis and spondylolysis are terms that are commonly used interchangeably. Isthmic spondylolisthesis is a defect in the pars interarticularis causing stress fractures in your spine, which is the definition of spondylolysis.
As confusing as this may sound, basically spondylolysis is the beginning stage of spondylolisthesis and may be the underlying cause of your condition.
In addition to spondylolysis, a slipped disc is commonly thought to be the same thing as spondylolisthesis, but in fact, a slipped disc isn’t technically a medical condition. Many of the disc injuries including herniated, bulging, ruptured, and degenerative are commonly mistaken for one another. Although spondylolisthesis involves the idea of “slipping” motion, it does not refer to the disc but the bone instead.
Can Being an Obese Individual Result in Spondylolisthesis?
In general, people who are overweight are at a much greater risk to suffer from back and spine pain, or any muscle or joint issues.
Essentially, the excess weight that is carried by an obese person puts additional strain and pressure on the spine. Thus, increasing potential injury to the spine and back.
People who suffer from obesity have an increased risk for problems specifically in the lumbar region (lower back). This leaves them more prone to spondylolisthesis as this condition most commonly occurs in your lumbar or lower back region. Being larger individual forces your spine to be pushed out of its normal position.
Read more about other back conditions you may be more susceptible to if you are a plus size individual.
What Are The Conservative Spondylolisthesis Treatment Options?
While there is no non-surgical spondylolisthesis cure, there are a number of ways to manage the symptoms and to slow any worsening of the condition. The first line of defense is often to give your back a rest and to take a break from any stressful activity. Keep in mind, when you’re able to return to a higher level of activity, you should do so gradually to prevent any worsening of spondylolisthesis.
Anti-inflammatory medications can help with the pain as well as any damaging inflammation. Another medication-based option for easing spondylolisthesis pain and other symptoms is an epidural injection of a steroid.
Engaging in spondylolisthesis exercises can be helpful both for managing pain and preventing any progression of the condition. It’s advised to try biking, swimming, or yoga to help your back heal and decrease your pain. Read more below for more examples of spondylolisthesis exercises!
A spondylolisthesis back brace that applies compression to the low back can be helpful to a similar end or as a supplement to spondylolisthesis physical therapy. A spondylolisthesis brace provides support to reduce the amount of strain on this region of the back and some spondylolisthesis braces, like these Back Supports, have massaging features to help ease tension in the lower back.
The Best Exercises & Stretches to Help with Spinal Spondylolisthesis
Exercises for spondylolisthesis typically focus on strengthening and improving the flexibility of the muscles of the back and abdomen. Such spondylolisthesis therapy can reduce the amount of strain on the back and result in major improvement in your back function. Make sure to consult your doctor before performing any of these exercises or stretches, as every individual's condition may be different than the next.
- Pelvic tilt: While laying down with your knees bent and your feet flat on the floor, flatten your lower back to the ground while engaging your abdominal muscles. Hold this position for 15 seconds then repeat.
- Crunches: While lying on the ground with your knees bent and your feet flat on the floor, place your arms over your chest. Next, slowly lift your head and shoulders (avoid using your next muscles) off the floor until you feel the contraction in your abdominal muscles. Hold in this position for three seconds then return to starting position, and then repeat.
- Knee to chest: While lying on the ground with your knees bent and your feet flat on the floor, pull your knees up to your chest. Hold this position for five seconds then repeat.
- Hamstring stretch: While sitting on the ground with your legs stretched in front of you and toes pointed towards the ceiling, slowly lean forward and reach your toes. Hold this position for 30 seconds then repeat.
Do I Need Spondylolisthesis Surgery?
If your condition continues to worsen in spite of conservative treatment methods or your spondylolisthesis results in compression of the nerves, spondylolisthesis surgery may be necessary. This typically involves fusing the vertebrae of the spine.
But this is typically pursued only after conservative methods have failed to slow the slippage of the bones of the spine as it involves risk (albeit slight) of temporary or permanent nerve damage that can diminish one’s sensation in the legs or even weaken or paralyze them.