Spondylolisthesis: How to Effectively Treat and Manage?

Everyone has likely experienced back pain at some point. However, what may seem like a common ache could be a warning sign of “spondylolisthesis,” a condition involving the slippage of one vertebra over another. If left untreated, this condition can lead to significant complications, particularly in older adults, who are more susceptible due to age-related spinal degeneration.
A thorough understanding of spondylolisthesis is, thus, essential for effective self-care and supporting the health of elderly family members.
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ToggleWhat is Spondylolisthesis?
Spondylolisthesis derives from the Greek words “Spondylo” meaning “spine” and “Olisthesis” meaning “slippage.” The human vertebral column is typically composed of a series of articulated vertebrae.
Spondylolisthesis, therefore, signifies an abnormal movement of a vertebra from its natural position in the vertebral column. This displacement can occur in various directions,
including anterior (forward), posterior (backward), or lateral (sideways).
Spondylolisthesis Who Is at Risk?
Older adults are the most at risk due to age-related degeneration of spinal structures. Women are particularly vulnerable, as hormonal changes and lower muscle strength contribute to bone weakening.
Additionally, physically demanding lifestyles, long-hours work, strenuous activities, extensive walking, heavy lifting, and high-impact sports increase the likelihood of developing spondylolisthesis.
Common Causes
Spondylolisthesis can arise from various factors, categorized into six main factors as following:
- Congenital Spondylolisthesis: A rare condition caused by spinal malformations present at birth, which can predispose individuals to vertebral slippage later in life.
- Isthmic Spondylolisthesis: Caused by a defect or fracture in the pars interarticularis, the bony bridge connecting adjacent vertebrae. This defect may result from stress fractures, acute fractures, or elongation, leading to slippage of the upper vertebra over the lower vertebra, ultimately causing spondylolisthesis.
- Degenerative Spondylolisthesis: The most common type, associated with aging, often occurs in individuals over 50 and is more prevalent in women. Degeneration of spinal discs, joint laxity, and weakened ligaments contribute to this condition, typically affecting the lumbar region (L4-L5).
- Traumatic Spondylolisthesis: Resulting from significant trauma, such as car accidents or falls, which can cause severe impacts, fractures, or dislocations. These injuries may increase the risk of vertebral slippage, leading to spondylolisthesis.
- Pathological Spondylolisthesis: Caused by certain diseases, such as cancer or tumors, that invade and compress the vertebrae, ultimately causing vertebral slippage.
Recognizing the Symptoms
The structure of the spine includes joints, surrounding muscles, and a spinal canal that houses numerous nerves. As a result, the symptoms of spondylolisthesis can vary depending on the affected spinal area. Key warning signs include:
- Pain: Pain can originate from both the affected vertebrae and the surrounding muscles. This may occur in the lower back, hips, or lumbar region.
- Movement-Induced Pain: This pain is linked to spinal instability. Discomfort may arise during activities such as bending forward, arching backward, or transitioning from sitting to standing.
- Muscle Stiffness: Back muscles may become tight or experience spasms as they compensate for spinal instability. This can lead to a sense of stiffness, tenderness upon palpation, or early fatigue during minimal exertion.
- Numbness or Weakness: Spinal nerve compression may cause numbness or weakness in the legs and feet. In some cases, this may be accompanied by radiating pain down the legs.
- Radiating Pain: This pain commonly occurs when vertebral displacement compresses the spinal nerves. Patients may experience sciatica-like symptoms, including pain radiating from the lower back to the legs. This pain often intensifies with prolonged standing or walking and subsides during periods of rest.
Diagnosis
Back pain, the primary warning sign of spondylolisthesis, can also be a symptom of other conditions. Therefore, accurate diagnosis is critical for confirming spondylolisthesis and developing an effective treatment plan that addresses the underlying cause. Typically, physicians rely on the following diagnostic methods:
- Medical History and Physical Examination: This includes a thorough assessment of the patient’s general health, lifestyle, and any risk factors that may contribute to the development of spondylolisthesis.
- X-rays are performed from various angles, including front, side, and back views, as well as flexion positions. These images help detect vertebral displacement and identify the affected areas of the spine.
- Magnetic Resonance Imaging (MRI): In cases where patients experience radiating pain, numbness, or weakness, an MRI is used to identify the precise area of nerve compression. This is essential for planning targeted treatments.
- Computed Tomography (CT) Scan: For cases involving traumatic spondylolisthesis, a CT scan provides detailed imaging to assess spinal injuries, detect fractures, and pinpoint vertebral displacement. This ensures a precise and effective treatment strategy.
Treatment Options
Treatment for spondylolisthesis depends on the underlying cause and severity of the condition. It is generally divided into non-surgical and surgical approaches:
1.Non-Surgical Treatments
Non-invasive treatments are often effective for older adults experiencing spondylolisthesis due to degenerative spinal changes. These individuals commonly present with back pain or radiating leg pain caused by nerve compression resulting from vertebral displacement. The following non-surgical approaches can be employed:
1.1 Behavioral Modifications: This involves resting the back and avoiding activities that exacerbate back pain, such as heavy lifting, extensive walking or running, strenuous exercise, and prolonged sitting.
1.2 Medications: If pain is primarily due to inflamed facet joints or muscle spasms, analgesics and muscle relaxants may be prescribed. For patients experiencing radicular pain and numbness due to nerve compression, neuropathic pain medications may also be considered.
1.3 Physical Therapy: In cases of muscle spasms, modalities such as ultrasound, laser therapy, spinal traction, or other techniques may be used to alleviate pain. Once the pain subsides, strengthening exercises targeting the back muscles may be introduced to improve the patient’s condition.
1.4 Spinal Bracing: Providing external support through the use of a spinal brace can reduce pain.
1.5 Epidural Steroid Injections: Injections of corticosteroids into the epidural space can also alleviate pain.
2.Surgical Treatments
Surgical intervention for spondylolisthesis is typically considered when non-surgical treatments fail to alleviate symptoms, or when patients experience persistent back pain and nerve compression severe enough to disrupt daily life. The choice of surgical method is determined based on the severity of the condition and the patient’s specific symptoms. The primary surgical options include:
2.1 Spinal Decompression Surgery: This procedure is typically recommended for patients with mild back pain but significant radiating leg pain, numbness, or weakness resulting from nerve impingement. The surgery can be performed using either open surgery or minimally invasive techniques, such as those utilizing a microscope or endoscope.
2.2 Spinal Fusion Surgery: This procedure is considered for patients with severe back pain and nerve compression caused by spondylolisthesis. In such cases, spinal fusion surgery is typically performed in conjunction with spinal decompression surgery. This procedure involves stabilizing the affected vertebrae by inserting metal implants to support the spinal alignment.
The adjacent vertebrae are then fused together to restore the natural alignment of the spine. Various surgical techniques can be employed for spinal fusion, such as:
- Lateral Approach: (OLIF: Oblique Lumbar Interbody Fusion and DLIF: Direct Lateral Interbody Fusion)
- Anterior Approach: (ALIF: Anterior Lumbar Interbody Fusion)
- Posterior Approach: (TLIF: Transforaminal Lumbar Interbody Fusion and PLF: Posterior Lumbar Interbody Fusion) Posterior approach surgery may involve minimally invasive techniques, such as placing metal implants through small incisions along the spine while utilizing a microscope or endoscope. This method is referred to as MIS TLIF (Minimally Invasive Transforaminal Lumbar Interbody Fusion) or Endoscopic TLIF (Endoscopic Transforaminal Lumbar Interbody Fusion).
Advances in spinal surgery have increasingly focused on Minimally Invasive Surgery (MIS) techniques, which offer numerous benefits including smaller incisions, less postoperative pain, reduced blood loss,
minimized muscle damage, and faster recovery times for patients.
Pre-Surgical Care
Preparing for spondylolisthesis surgery is similar to other surgical procedures. Patients are required to undergo a preoperative health check to assess their physical readiness for the operation. This typically includes blood tests, X-rays, and an assessment of cardiac health. Additionally, patients are advised to stop smoking and avoid alcohol to minimize surgical risks.
For patients on anticoagulants for other medical conditions, close consultation with the physician is essential. In some cases, temporary discontinuation of anticoagulants may be necessary before surgery, subject to an evaluation of the patient’s condition.
Post-Surgical Care
Proper postoperative care and adherence to your doctor’s advice are crucial for a smooth recovery and a return to normal activities. Here are essential guidelines to follow after spinal surgery:
- Keep the Surgical Wound Dry: During the initial two weeks following surgery, it is important to avoid getting the wound wet to prevent infection and inflammation. Once the stitches are removed, normal bathing and water exposure can typically resume.
- Avoid Straining the Spine: In cases involving spinal fusion, extra caution is necessary to allow the fused vertebrae to stabilize fully, which usually takes at least three months. Patients should avoid lifting heavy objects, frequent bending, sitting on low chairs, or sitting directly on the floor, as these activities can increase pressure on the spine and hinder recovery.
- Adjust Your Posture Regularly: Avoid prolonged sitting in one position. It is recommended to change positions every hour to minimize pressure on the surgical site. Walking, standing, and light daily activities are encouraged, but patients should avoid rushing into strenuous tasks too soon.
Prevention Tips: How to Protect Yourself from Spondylolisthesis
Implementing proactive self-care measures and encouraging loved ones to adopt healthy habits can play a vital role in reducing the risk of spondylolisthesis. The following strategies are simple yet effective:
- Avoid High-Risk Activities: Steer clear of activities that can strain the spine, such as lifting excessively heavy objects, repetitive lifting, or prolonged periods of heavy lifting.
- Be Cautious During Exercise and Sports: Athletes, especially professionals, should exercise caution to avoid overstraining the spine. Persistent back pain warrants prompt medical evaluation to rule out potential underlying conditions like spondylolisthesis, ensuring early treatment.
- Focus on Strengthening Back Muscles: Incorporate exercises to strengthen the back muscles, which play a vital role in supporting the spine and reducing the likelihood of vertebral displacement.
While spondylolisthesis can arise from various causes, it most commonly results from age-related spinal degeneration or high-risk physical activities. If chronic back pain persists for over three months, especially when accompanied by leg pain, numbness, or muscle weakness, it’s advised to seek medical evaluation. Early diagnosis enables effective treatment options, including both surgical and non-surgical approaches, tailored to the severity of the condition. The best outcomes occur under the guidance of an orthopedic specialist or spine surgeon.
Article by: Jirachai Pisutbenya, M.D., Specialist Spine Surgeon