
Spondylolisthesis comes from the Greek words spondyl, meaning “whorl,” plus olisthesis (dislocation), derived from olisthanein, meaning “to slip, slide, or fall.” Simply put, spondylolisthesis is the displacement, slippage, or subluxation of a vertebra.
Your spinal column is made up of flat, more or less round or ring-shaped bones called vertebrae. They’re stacked up like poker chips and connected by supporting structures, including the intervertebral discs that lie between them.
A misaligned vertebra can compress spinal nerves, causing a kind of pain
called radiculopathy, or it can impinge on the spinal cord itself, causing
pain and dysfunction known as myelopathy.
Spondylolisthesis can occur in the cervical spine, usually at the level
of the third and fourth cervical vertebrae or the fourth and fifth cervical
vertebrae. Vertebral displacement can also occur in the thoracic spine.
But it’s most common in the lumbar spine (the lower back) at the
level of the fourth and fifth vertebrae.
Spondylolisthesis is frequently preceded by spondylosis—age-related degeneration of the spine. The term spondylosis is used interchangeably with the term osteoarthritis of the spine.
Spondylolisthesis can cause severe back pain, particularly radiculopathy. Other symptoms are common as well, although not all patients have all symptoms. Your symptoms will depend on the location of the displaced vertebra:
Patients with cervical spondylolisthesis tend to have focal neck pain that gets worse when the neck is flexed forward or backward. “Focal” just means that the pain is focused—that is, you can point to the spot where it hurts. The opposite would be a generalized “it hurts all through here” kind of pain.
Patients with lumbar spondylolisthesis tend to have focal lower back pain. Sometimes the pain improves when lying down since that position stabilizes the spine. A displaced lumbar vertebra may also produce sciatic pain in the leg or buttocks, weakness in the legs, or difficulty walking. Walking may intensify the pain.
There are several forms of spondylolisthesis:
If you have spondylolisthesis but have no symptoms, treatment is unnecessary.
If the displacement is causing progressive spinal cord compression, though, you probably do have pain and other symptoms. Unfortunately, myelopathy associated with spondylolisthesis won’t go away on its own. Eventually, a surgical procedure will be necessary to subside the symptoms and pain.
If your condition is causing pain or dysfunction, such as difficulty walking, treatment is needed. Your doctor will probably try conservative measures first—that is, therapies that don’t require a scalpel or heavy-duty prescription drugs.
Cervical collars, traction, physical therapy, and injections are good options for some patients. Many doctors follow a four-pronged approach to the initial management of spondylolisthesis:
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen (Aleve) and ibuprofen (Advil) are great at relieving the pain of spondylolisthesis. Sometimes they’re more effective than muscle relaxants, opioid medications, or short-term oral corticosteroids.
Aerobic physical activity promotes blood flow to areas of nerve compression in the spine and strengthens muscles and other supporting structures. Walking, swimming, and use of an elliptical machine are suitable aerobic conditioning activities, but the use of a stationary bicycle is especially useful for patients with spondylolisthesis.
Look for a bike in which the pedals are more or less below the seat (like on a real bicycle), rather than choosing a recumbent bike in which the pedals are out in front of you. A more traditional configuration of the seat, pedals, and handlebars shifts your weight toward your upper body. In contrast, a recumbent bike directs your body weight toward the seat, thereby putting pressure on your lumbar spine.
If you’re overweight or obese, your doctor may recommend that you lose weight. The less body weight the spine must support, the less it will hurt. That theory, of course, doesn’t always pan out in practice. But if you’re overweight, it’s a gamble worth taking, since weight loss produces a wide range of other health benefits unrelated to the spine.
Osteoporosis weakens bones, leading to fractures and other problems. To prevent or slow the progression of spondylolisthesis, your doctor will keep a careful eye on your bone mass to ensure that the bones of your spine are as dense, strong, and healthy as possible.
Inspired Spine is Minnesota’s leading spine center. We are a total spine care provider dedicated to relieving chronic back pain with the least invasive treatment possible.
Questions? Contact us at Inspired Spine to speak to a Patient Care Coordinator by calling (952) 225-5266.
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