Spondylolisthesis refers to the condition where one vertebra shifts forward over another, impacting both the motorway and slip road within the spinal system (Read About Spinal Motorways). This displacement gives rise to various associated symptoms.
An X-ray of the lumbar spine can vividly illustrate this forward movement, where one vertebra outlines in red advances over the other.
Most issues associated with spondylolisthesis occur at the tunnel level, where the keyhole-shaped passage becomes distorted, leading to nerve entrapment and shooting leg pain. Patients with spondylolisthesis often present with both back and leg pain. However, some may experience only claudication leg pain, necessitating a clear understanding of these two distinct symptoms.
The Tunnel or Foramen outlined in blue is a Keyhole shaped passage through which the cars (Nerve -Outlined in green) passes on its way to their destination. The tunnel collapses and gets distorted during spondylolisthesis causing entrapment of nerve (Outlined in red).
There are six types of spondylolisthesis, each with similar symptoms:
1. Isthmic or Lytic (Pars Fracture):
- Occurs due to a defect in the pars interarticularis, resembling a break in the bridge that joins the roof tiles.
- Typically results from abnormal stress during childhood or adolescence, often related to activities involving repeated backward bending, such as gymnastics and cricket fast bowling.
- Fractures may not unite over time, leading to persistent back pain.
CT scan of lumbar spine showing normal roof tile arrangement of facets (outlined in blue) and fracture or break at the lower tile (red arrow).
MRI of lumbar spine illustrating forward movement of one vertebra (outline in red) over other. The disc height at this level has completely collapsed.
- Age-related degeneration, typically involving the L4-5 level.
- Not commonly associated with pars injury.
- Assessment is essential to rule out other non-spinal causes of symptoms.
- Often due to high-impact injuries.
- Many cases require spinal fixation for stability.
- Occurs as a result of a fracture in diseased bone, such as infection or a tumor.
- A rare condition stemming from a developmental defect in the spine.
- Develops as a result of previous spinal surgery.
Treatment can be divided into non-operative and operative approaches. Non-operative options encompass physiotherapy, yoga, pain management with appropriate medications, and alternative therapies like acupuncture. Epidural injections and nerve root blocks may serve diagnostic and therapeutic roles if surgery is not under consideration. However, these injections are not considered a cure and may offer limited long-term benefits.
Operative treatments may involve limited decompression or fusion procedures, depending on the patient’s symptoms and therapeutic goals. These options are discussed during pre-operative consultations. Decompression primarily addresses leg pain by clearing the motorways. Fusion procedures aim to alleviate both leg and back pain symptoms. Generally, improvements are more significant in leg pain compared to back pain.
Understanding spondylolisthesis and its various forms is vital for informed decision-making and tailored treatment approaches.
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Note: Medical conditions should always be discussed with a qualified healthcare professional. This content is for informational purposes only.