Spondylolisthesis occurs when a vertebra slips forward over the vertebra below it. A vertebra is one of the bones that make up the bony architecture of the spine to form the spinal canal. This most commonly occurs in the lower back.
During physical activity or even rest, our spine endures pressure as it manages our body's weight. The spine's pressure to absorb our body weight along with everyday movements leads to excessive stress that can result in one of the vertebrae slipping forward over the vertebrae beneath.
Fractures or Facet Joint Syndrome are conditions that can cause a slipped vertebra. The facet joints are the articulations between each vertebra in the spine. Over time, the facet joints can degenerate and cause a slippage, also known as a Spondylolisthesis.
Spondylolisthesis may or may not cause symptoms. The severity of symptoms depends on how far the vertebrae has slipped and includes:
Back pain and stiffness
Muscle spasms and tightness in the legs
In severe cases, the vertebrae may slip so far forward that it puts pressure on the spinal nerves. Pressure on these nerves can cause an array of symptoms, including:
Severe back pain and weakness
Leg pain, numbness and tingling, and weakness (also known as Radiculopathy)
Diffuse leg pain
Issues with reflexes
The above symptoms may be amplified when standing for a long period of time or when walking, which is known as Neurogenic Claudication due to Spinal Stenosis. Sometimes sitting down or leaning forward may alleviate these symptoms by taking pressure off of the nerves. Rarely, in addition, loss of bowel and bladder function can occur, also known as Cauda Equina Syndrome. If you suspect you have Cauda Equina Syndrome, seek prompt medical treatment.
To diagnose, your doctor will perform a clinical exam and ask you a number of questions regarding your symptoms. Your doctor may look for abnormalities via a physical examination, X-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI).
Treatment will be determined by the severity of the slippage. There is a grading scale based upon how far the vertebra has moved out of place (the majority of cases are Grade 1 or 2):
Grade 1: Less than 25% of slippage
Grade 2: 25-50% of slippage
Grade 3: 50-75% of slippage
Grade 4: Greater than 75% of slippage
In a Grade 1 or 2 slippage, treatment can be non-surgical, focusing on improving mobility with physical therapy and pain management techniques. The doctor may recommend over-the-counter medications to help reduce pain. Sometimes, relief is found using steroids to help reduce inflammation. If these methods fail, your doctor may recommend Epidural Steroid Injections.
During an Epidural Steroid Injection, the doctor uses a live x-ray image to place medicine directly near the area that is inflamed and causing pain. This is a short outpatient procedure that takes place in a surgical center, doctor's office, or hospital.
When non-surgical treatment fails to provide relief, symptoms begin to progressively worsen, an individual has bowel or leg impairment, or a Grade 3 slippage or higher is present, surgery may be recommended.