Spondylolisthesis a disorder characterized by spinal instability, in which the vertebrae move abnormally, and is usually caused by a sports related injury. Genetics may play a role in the likelihood of a spondy occurring in a person that plays football, gymnastics, or a similar sport. A spondy usually occurs in the lumbar spine or low back and is described as one bone or vertebra slipping or sliding forward over the vertebra below it. This forward or anterior position may lead to the spinal cord or a nerve being compressed or squeezed. For instance, a vertebra slips out of place onto the vertebra below. Consequently, it may put pressure on a nerve, which could cause lower back pain and/or leg pain with associated paresthesias (numbness, tingling, burning, aching, cramping, pins & needles). This condition typically occurs due to the general aging process in which the bones, joints, and ligaments in the spine become weak and unable to hold the spinal column in alignment. This can occur in any level of the spine but is most common in the lumbar spine.
Symptoms
Sometimes when a vertebra slips out of place, there maybe no symptoms or a delay in the onset of symptoms. Patients with a spondy may experience the following symptoms:
- Pain in the low back or buttock area
- Pain may increase with coughing or sneezing
- Weakness, numbness or pain in one or both legs
- Hamstrings may feel tight
- Leg muscles may feel tight or weak
- Patients may limp or waddle
- Posture may change and the patient may lean forward
- Trying to stand maybe painful or difficult to achieve
- Loss of bladder or bowel control may occur
Treatment
Non-Surgical Treatments
For most cases of Spondylolisthesis (especially Grades I and II), treatment consists of temporary bed rest, restriction of the activities that caused the onset of symptoms, pain/anti-inflammatory medications, steroid-anesthetic injections, physical therapy, and spinal bracing.
Degenerative Spondylolisthesis can be progressive, which implies that the injury can worsen over time. In addition, spondylolisthesis can cause stenosis, a narrowing of the spinal canal with spinal cord/nerve compression. Surgery may be required if the stenosis is severe and all non-surgical therapies are unsuccessful.
Surgical Treatments
Surgery is rarely needed unless the case is severe enough (usually Grade III or above), neurological damage has occurred, the pain is disabling, and/or all non-operative treatment options have failed.
The most common surgical procedure used to treat Spondylolisthesis is called a laminectomy and fusion. In this procedure, the spinal canal is widened by removing or trimming the laminae (roof) of the vertebrae. This creates more space for the nerves and relieves pressure on the spinal cord. Additionally, the surgeon might need to fuse vertebrae together. If spinal fusion is performed, different devices (such as screws or interbody cages) may be placed to support the fusion and stabilize the spine.
Fusion at the lumbar spine can be achieved by various methods.
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