What is a Spondylolisthesis? Is it as Bad as it Looks?

As you are probably aware, your spine is made up of a series of connected bones called "vertebrae."

In about 5% of the adult population, a crack develops in one of the vertebrae and may later develop as a stress fracture. Due to the constant forces the low back experiences, this fracture does not usually heal like a normal bone.

This type of fracture is called a spondylolysis and may cause no problem at all unless you are a sportsperson. However, sometimes the cracked vertebra does slip forward over the vertebra below it. Once this slippage occurs, the condition is known as a spondylolisthesis and can more readily cause pain or discomfort.

This is most common leavl that a spondylolisthesis occurs is at L5/S1 (the point at which the fifth lumbar vertebra articluates with your sacrum.

What are the Symptoms of Spondylolisthesis?

Spondylolisthesis may not cause any symptoms for years (if ever) after the slippage has occurred. If you do have symptoms, they may include:

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How is Spondylolisthesis Diagnosed?
Your physiotherapist will begin by taking a history and performing a physical examination.

A palpable step or depression may be present to indicate the likelihood of a spondylolisthesis. Your physiotherapist may order X-rays of your back. However, sometimes it is difficult to see on a plain, so additional tests may be needed.

A CT scan or MRI scan can show a crack or defect in the bone more clearly. They will also show whether any of the nearby discs have suffered any wear and tear because of the spondylolisthesis.

If a spondylolisthesis is present, it is graded as I (mild), II, III or IV (severe) based on how far forward the vertebra has slipped.

Treatment for Spondylolisthesis

If your physiotherapist or doctor determines that a spondylolisthesis is causing your pain, they will usually try nonsurgical treatments at first.

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Surgery?

Surgery is reserved for a very small percentage of patients whose pain cannot be relieved by nonsurgical treatment methods. If a spinal nerve is being compressed by the forward slip, surgery may be needed to reopen a "tunnel," or space, for the nerve.

Alternatively, a stabilising procedure or fusion may be recommended. This will stop any further slippage of the vertebra and also will prevent recurrent nerve pressure from developing at this site. Your options are best discussed with your Orthopaedic Surgeon.