If you have been experiencing a progressive tightening of your lower back and hamstrings, and the pain and discomfort has become so great you have been forced to adjust your posture and change the way you walk, you might be suffering from a degenerative condition called spondylolisthesis.
Spondylolisthesis refers to a forward displacement of a vertebra, particularly in the lumbar region. It is a distinct condition from a slipped disk which is a tear in the fibrocartilaginous joint between two vertebrae.
Spondylolisthesis can become so acute it can force sufferers to adopt a kyphotic (hunchback) stance, or even waddle as they walk as their pelvis must compensate for the decreased flexibility in the lumbar region. Patients often experience persistent lower back pain accompanied by periodic shooting pains in the thighs and buttocks.
Degenerative spondylolisthesis is a serious condition but there are many safe and effective treatment options available. Many patients are effectively treated with conservative, nonsurgical therapy. For patients who may be appropriate candidates for surgical options, there are safe and effective interventions for this disorder. Contact the Ainsworth Institute of Pain Management for information on all your options.
What is a Spondylolisthesis?
Spondylolisthesis is a spinal condition in which one vertebra slips forward over the vertebra below. Degenerative spondylolisthesis usually occurs in the lumbar (low back) spine, more commonly at L4-L5 (4th and 5th lumbar vertebral levels). Spondylolisthesis can result from degenerative changes in the vertebral structure that causes the joints between the vertebrae to slip forward and may lead to spinal stenosis.
Degenerative spondylolisthesis occurs in 4-6% of the U.S. population. It most common among female patients over the age of 60. Spondylolisthesis is also prevalent among children and teens involved in sports, particularly weightlifting and gymnastics.
More About Spondylolisthesis
Information from your medical file and imaging studies is used to grade the degree of vertebral slippage from mild to severe. Doctors use the Meyerding Grading System to classify the degree of vertebral slippage. This system is easy to understand. Slips are graded on the basis of the percentage that one vertebral body has slipped forward over the vertebral body below.
Grade I: 1-24%
Grade II: 25-49%
Grade III: 50-74%
Grade IV: 75%-99% slip.
Grade V: Complete slip (100%), known as spondyloptosis
Treatment will be based on the degree of slip and factors, such as intractable pain and neurological symptoms. Most cases of degenerative spondylolisthesis are Grade I or II. In general, the more severe the slip (Grades III and above), the more likely surgical intervention will be required.
What are the Symptoms of a Spondylolisthesis?
Some people with spondylolisthesis are symptom-free and discover the disorder when seeing their doctor for another health problem. Symptoms may include:
“Shopping Cart Sign” – pain that improves with leaning or hunching forward on things like a railing or shopping cart
Low back pain
Tight hamstring muscles
Irregular gait or limp (bowed back, waddling)
Spondylolisthesis occurs when some sort of problem with an intervertebral disc causes the vertebra to move forward and out of line with the rest. It can be caused by any one of a number of disk-related issues.
Congenital defective disc (from birth)
Injury or accident
How is a Spondylolisthesis Diagnosed?
An accurate diagnosis of spondylolisthesis can be made by a physician with expertise in spinal disorders. This may include the following steps.
Medical history – The doctor will inquire about symptoms, their severity, treatments you have already tried, and the results.
Physical examination – The physician will examine you for limitations of movement, balance problems, and pain. The physician will test your reflexes at the extremities and evaluate muscle weakness, loss of sensation, and signs of neurological injury.
Diagnostic tests – Spondylolisthesis is easily seen on a lateral (side) lumbar x-ray. If necessary, a CT scan or MRI may be ordered to see the spine’s tissues in greater detail.
Most cases of degenerative spondylolisthesis are treated without surgery. Treatment may include:
Short-term bed rest
Over-the-counter or prescription pain medication
Steroid injections (i.e. epidural steroid injection)
Degenerative spondylolisthesis can be progressive. This means the spondylolisthesis worsens with time and may cause spinal stenosis. Follow up with your doctor to monitor treatment progress and spondylolisthesis is important for recovery.
If your degenerative spondylolisthesis progresses or causes neurologic problems, such as incontinence, surgery may be recommended. Spinal instrumentation (i.e. rods, screws) and fusion (bone graft) are common procedures performed to stop slip progression and stabilize the spine. There are different types of instrumentation, bone graft and graft products, as well as procedures (some minimally invasive) to surgically treat degenerative spondylolisthesis. Surgeons will discuss the types of surgery and associated risks and benefits for patients who may be suitable candidates.
Schedule an Appointment Today
The doctors at the Ainsworth Institute of Pain Management specialize in treating spondylolisthesis. Dramatic improvements in pain and quality of life are a single phone call away. Schedule an appointment today with one of our board certified pain management experts to discuss what options for treatment may best suit your needs.