Spondylolisthesis

Back pain is a common complaint, experienced by nearly everyone at some point in his or her life. The causes of back pain are many and include trauma, inflammatory disease, tumors, congenital spine conditions, and even the degenerative process of aging.

You have likely heard of a “slipped disc” (or bulging, ruptured, or herniated disc), but you may not realize that a person can also suffer from a slipped vertebra. Spondylolisthesis is a spinal condition in which one vertebrae, or segment of the backbone, slips over another.

In some cases, a person may not experience any symptoms of spondylolisthesis. In other cases, it can cause severe back pain and may be associated with spinal stenosis, in which the spine becomes too narrow, placing pressure on the nerves.

Potential Causes

Like many other spine conditions, spondylolisthesis in adults is most frequently a degenerative condition caused by aging. However, the U.S. National Library of Medicine indicates that it can also be caused by birth defect, bone disease, acute injury, overuse sports injury, and stress fracture.

The American Association of Orthopaedic Surgeons (AAOS) lists the two most common types of adult spondylolisthesis as follows:

  • Degenerative spondylolisthesis
  • Spondylolytic spondylolisthesis

Degenerative spondylolisthesis occurs typically as a result of arthritis, which often begins with the deterioration of discs that cushion the vertebrae. The AAOS reports that arthritis can weaken the joints and ligaments that support and align the vertebrae.

When a lumbar (lower back) vertebra has insufficient joint support and rests on a flattened, deteriorated disc, it can slip out of place and move forward over the joint beneath it. When degenerative spondylolisthesis occurs, it may narrow the spinal canal, placing pressure on the spinal nerves. This condition is known as spinal stenosis.

Symptoms of spinal stenosis include back pain (often lower back pain if associated with spondylolisthesis); pain, numbness, or weakness of the legs; sciatica, or pain radiating in the buttocks or legs; and neurological problems including foot problems or “foot drop.”

Spondylolytic spondylolisthesis occurs as a result of a break in one of the vertebrae of the lumbar spine.

Often, this break is a fracture (called a pars fracture) that occurs in adolescence but goes undetected until the degenerative processes of adulthood weaken the fractured vertebra, causing it to slip forward.

While degenerative spondylolisthesis is most common in adults over age 50, spondylolytic spondylolisthesis is most common among middle-aged men.

How is Spondylolisthesis Treated

In general, spondylolisthesis is treated through non-surgical methods. For many people, the condition is improved by pain medications, anti-inflammatory medications, physical therapy and exercise, and/or steroid injections.

If the condition does not improve within several months, or if the slippage is severe or worsening, surgery may be recommended. Surgery for spondylolisthesis may include laminectomy, which reduces pressure on the spinal nerves, and spinal fusion, which stabilizes the affected vertebrae by fusing them together into a single bone.

To learn more about spondylolisthesis and associated conditions such as spinal stenosis, or to determine the source of your back pain, talk to a doctor.