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Spondylolisthesis

When a backbone slips forward onto the backbone beneath it, causing low back pain and leg pain

Facts and information

Although a diagnosis of spondylolisthesis (pronounced “spon-dl-oh-lis-THEE-sis) might sound intimidating, it is not necessarily a cause for concern. Despite the long name, this is a common condition that affects over three million Americans each year.

Spondylolistheis is often diagnosed in people who are born with a defect of the backbones. Additionally, like many other back problems, spondylolisthesis may appear as the spine wears down with age or repeated injuries. Although spondylolisthesis does not go away on its own, the pain can improve with medications, physical therapy, and treatments from a pain specialist.

Some facts about spondylolisthesis:

  • It is most common in the low back (lumbar spine) area.
  • It is most likely to appear after the age of 50 in both men and women, with women having a higher risk than men.
  • The ratio of female to male patients who develop this condition is 1.3 to 1 (13 women for every 10 men).

How spondylolisthesis starts

Spondylolisthesis involves an abnormal shift in the backbones the spine's building blocks that support the body and hold it upright. The backbones are stacked one on top of the other throughout the length of the spine. Between a backbone and the one above there is a cartilage disc and small joints that absorb shocks when a person moves.

  • For younger patients (under 50 years of age) spondylolisthesisstarts due to a birth defect that affects the backbones. This is known as a pars intrarticularis defect. People with this defect have a fracture (break) in the back part of a backbone, usually in the lower back. Their backbones start to shift out of place and eventually cause low back pain. A pars defect may not cause pain, initially. However, in time, it may start to cause low back pain.
  • A common cause for spondylolisthesis for patients over 50 years of ageis a gradual wear-and-tear of the discs, joints, and other structures in the back. Your pain specialist may refer to this as “degenerative changes in the spine”. People with this type of spondylolisthesis have low back pain due to worn-out discs (Degenerative Disc Disease), pseudoarthrosis (a painful bone-on-bone rubbing between two backbones), or irritated nerves (Lumbar Radiculopathy).

Symptoms

The symptoms depend on the place in the spine where there is a shift between backbones. Spondylolisthesis most often affects the L4-L5 backbones in the low back area.

A person may complain of:

  • Low back aches and stiffness
  • Shooting leg pain
  • Numbness, weakness, or tingling in a leg or foot
  • Tight hamstring and buttock muscles
  • Increased leg pain with walking
  • Relief from pain when sitting or laying down

Diagnosing spondylolisthesis

A first step in diagnosing this condition is obtaining a patient history and performing a physical exam. People with spondylolisthesis may have difficulty raising their leg straight outward during simple exercises.

The following imaging tests help:

  • Flexion/Extension X-rays are taken as a person bends forward and then stretches backwards. They show if a backbone is fractured or has shifted out of place.
  • A CT scan shows if the shifted backbones are pressing on a nerve in the spine.
  • An MRI scan shows damage to tissues such as the discs and nerves.

Treating spondylolisthesis

While this condition won’t go away most people find relief through rest, medications, weight-loss, physical therapy, and wearing a back brace. For mild to moderate pain, a pain specialist can offer injections and minimally invasive procedures that relieve pain without surgery (see treatments below). In cases where the backbones shift significantly and a person has severe, continuous pain, you may need to see a surgeon for evaluation and a possible spinal fusion surgery.

For more information about the treatments offered by pain specialists, click on the terms below.

TREATMENTS:

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