Spondylolisthesis refers to the forward (anterior) or backward (Retro) displacement of a bone in the vertebral column, leading to misalignment of the vertebral bodies in the spine. It is not the same as a herniated disc, although the two can coexist. With spondylolisthesis, the slippage is of the bony vertebra. With a herniated or ruptured disk, it’s the soft interior of the spinal disc that “slips,” or bulges through a tear in the outer layer of the disc.
This spinal deformity may be degenerative, congenital, pathogenic or traumatic, and results in low back pain and sciatic nerve pain, with changes in posture and gait. Isthmic spondylolisthesis is the most common form, which occurs with a slip or fracture of the intervertebral discs. When spondylolisthesis occurs in children or teens, it is usually due to a birth defect or a traumatic injury. (In fact, spondylolisthesis is the most common cause of back pain in teens.) In adults, the most common cause of spondylolisthesis is natural wear and tear due to aging and arthritis.
Symptoms of spondylolisthesis range in severity, depending on the location and cause of the slippage. Some people may have no pain at all, or have only mild back pain. However, as the condition worsens, symptoms may include:
- Low back pain, ranging from mild to severe
- Hamstring muscle tightness or spasms
- Buttock pain, numbness, or tingling
- Back stiffness
- Weakness or tingling of the legs and feet
- Tenderness around the area of the slipped disc
Once a diagnosis of spondylolisthesis is made, the doctor will grade the degree of disc slippage and prescribe a specific course of treatment
Non-surgical treatment options include physical therapy. The modalities employed include exercises and addressing postural movement abnormalities. Thermal treatment, lumbar traction, and electrical stimulation may help with the reactive muscle spasm seen in spondylolisthesis.
Medications used to treat spondylolisthesis include nonsteroidal anti-inflammatory medications, combined with acetaminophen. If there is severe neural pain, a course of corticosteroids may be tried, including oral prednisone. Epidural steroid injections can be administered into the interlaminar or transforaminal spaces under fluoroscopic guidance, and are often of benefit in treatment of neural pain radiating to the leg. Use of a lumbosacral orthotic device may be of use for a short period of time, but if used for longer periods of time may cause spinal muscle atrophy and proprioceptive loss.
Finally, when surgery is not an option, neuromodulation can be a worthwhile option.