Hi Everyone, the next topic we want to discuss in our spinal dysfunction series is Spondylolisthesis. In todays blog we will explore what spondylolisthesis is, how it occurs and how to manage it.
Spondylolisthesis is a spinal condition that affects the lower vertebrae (bones in the back). It involves the slipping of part or all of one vertebra forward on the bone directly beneath it. In order to understand how it occurs a basic knowledge of the anatomy of the vertebra is beneficial.
A vertebra itself is composed of:
1. The vertebral body
2. Vertebral foramen (spinal cord runs)
4. Transverse process
6. Spinous process
In Spondylolisthesis, stress fractures occur at the pars interarticularis (this is known as spondylolysis). This is the part of the lamina that is located between the facet joints of the vertebra.
These stress fractures can occur on one or both sides. When they occur on both sides the vertebral body can slip forward from the spinous process resulting in the condition known as spondylolisthesis.
Spondylolisthesis reduces stability through the spine and can place pressure on discs and nerves resulting in neurological damage, though the actual cases that progress this far are rare.
Causes of spondylolisthesis is based on age, heredity and lifestyle factors. It’s commonly seen in children between the ages of 9 -14. It can be a birth defect, result of trauma or an overuse injury (stress fracture).
Spondylolisthesis is graded according to the degree of slip of the vertebra:
Grade 1: the vertebra has slipped up to 25% over the body of the vertebra underlying it
Grade 2: displacement is greater than 25% over the body of the vertebra underlying it
Grade 3: slip is greater than 50% over the body of the vertebra underlying it
Grade 4: slip is greater than 75% over the body of the vertebra underlying it
Signs and Symptoms of Spondylolisthesis
People with mild cases (grade 1) may not have any symptoms at all. Grade 2 or higher may result in persistent low back pain, with or without radiating leg pain (tingling, numbness, weakness) stiffness in the back, legs, hamstrings or buttock muscles.
Symptoms are commonly aggravated by extension, or bending back, activities. When we adopt extension through the spine, we place more load on the back of the vertebra and, in the case of spondylolisthesis, this puts pressure on the pars interarticularis defect and can push the vertebral body further forward creating pain.
Can it be Treated?
Spondylolisthesis is a common condition and often asymptomatic. In those people with symptoms it can be managed quite effectively through physiotherapy or chiropractic treatment. Treatment initially involves pain management by releasing muscles that may have spasmed as well as mobilising the joints around the area to improve range of movement.
Once appropriate range of movement is restored, you would be progressed to the most beneficial part of treatment which is a targeted strengthening program. These exercises are designed to increase the stability around the hip and lower back to minimise excessive movements that cause pain.
Should conservative management be unsuccessful, more invasive measures such as corticosteroid or epidural injections and or surgical procedures may be explored.
Patients with grade I-II spondylolisthesis respond well within the first few weeks of conservative management, whereas grade III+ have less favourable outcomes and may need stabilisation surgery. Surgery is more so considered when there is failed improvement with muscle weakness, poor function or other neurological deficits including interruption to bladder and bowel function.
Spondylolisthesis has many causes, so it is difficult to predict and thus prevent. However, maintaining a strong, healthy and supported spine goes a long way to reducing the level of pain and disability associated with all back conditions, so follow these tips to minimise your risk of injury:
1. Keep moving, the back is a strong and robust structure that was designed to move so keep on moving.
2. Exercise your core muscles regularly to ensure your spine stays supported
3. Practice good habits at work, whether it be good ergonomics at your desk or lifting with correct technique, make sure you take care of your back
4. Stretch & strengthen your hamstrings. The hamstrings play a critical role in the position of our low back so make sure they stay flexible and strong.
So that’s a brief overview spondylolisthesis, if you experience any of the symptoms or discomfort as described above, seek advice from your healthcare practitioner as soon as possible.
If you have any questions or comments, feel free to email us at firstname.lastname@example.org and we’ll happily answer them for you.
If you think you might be suffering from spondylolisthesis and want relief today, call us on (08) 9486 8653 and we will arrange an appointment for you.