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 is most common among older female patients, usually over age 60.
Symptoms
Some people with spondylolisthesis are symptom-free and discover the disorder when seeing their doctor for another health problem. Symptoms may include:
- Low back pain
- Sciatica
- Muscle spasms
- Leg weakness
- Tight hamstring muscles
- Irregular gait or limp
Diagnosis
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.
Classification of 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.
Nonoperative Treatment
Most cases of degenerative spondylolisthesis are treated without surgery. Treatment may include:
- Short-term bed rest
- Activity restriction
- Over-the-counter or prescription pain medication
- Anti-inflammatory medication
- Muscle relaxants
- Steroid injections (i.e. epidural steroid injection)
- Physical therapy
- Bracing
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.
Surgery
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.
Conclusion
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.