Spondylolisthesis is when a bone in the spine (vertebra) slips out of place, usually forwards relative the vertebra below. Most commonly this occurs because of degenerative arthritis wear-and-tear changes. It also often occurs because of stress fractures through a part of the vertebra known as the pars. These stress fractures are known as pars defects or termed spondylolysis. These are thought to occur most commonly in childhood but usually do not cause significant symptoms until many years later. More rarely it may be seen in people born with vertebra which have not formed normally. Again, this is often not identified until much later in life when it causes symptoms.
Spondylolisthesis can cause symptoms including:
- lower back pain and stiffness;
- buttock, groin and leg pain;
- abnormal sensations in the buttocks, groin and legs;
- weakness in legs;
- difficulty with passing water or incontinence;
- difficulty walking or running.
Spondylolisthesis may be diagnosed on X-ray, CT or MR imaging.
Optimal treatment relies on accurate diagnosis to identify the exact underlying cause of spinal symptoms. Diagnostic imaging technology has evolved to the point where we are able to produce high resolution images of the spinal column, intervertebral discs and nerves and pinpoint precisely where an issue has arisen.
MRI (magnetic resonance imaging) is generally recognised as the gold standard investigation for spinal pathology in most circumstances. CT scans and X-Rays can produce excellent images of broken, fractured or misaligned bones. However, CT scans and X-Rays cannot display soft tissues, such as discs or nerves, as clearly as MRI. Specialised X-rays, termed EOS imaging, can be very useful for spinal deformity such as scoliosis. SPECT-CT (single photon emission computed tomography-CT) combines CT imaging with a very low dose of radioactive tracer and can be used to diagnose or localise excess activity as seen in active arthritis or degenerate disc disease.
Sometimes electrical tests such as nerve conduction studies and electromyography can be useful to determine the source of symptoms particularly if they are caused by a peripheral nerve problem such as generalised neuropathy from diabetes or compression as seen in common peroneal entrapment. These often produce symptoms also seen in spinal conditions and may co-exist with spinal pathology.
Combining these and other diagnostic tests can aid accurate diagnosis to optimise treatment and improve outcomes.
There are many ways to treat spondylolisthesis. The appropriate treatment will depend on various factors including the severity of the symptoms, the extent of neural compression, the degree of vertebral slip and the patient’s age and overall health.
Initial treatment may be simply avoiding straining including heavy lifting, twisting or jerking movements or sports which exacerbate the symptoms. This can give your back a chance to get back to your normal followed by targeted multimodal non-invasive therapy including physiotherapy with core strengthening. For some patients, combined steroid and local anaesthetic injections could be considered. These aim to reduce inflammation and pain.
Sometimes surgery is the best option. Surgical options include decompression or decompression and fusion. Decompressive surgery for spondylolisthesis is usually a laminectomy. These are generally indicated only for mild spondylolisthesis without significant back pain. Lumbar fusion surgery may be performed via anterior, lateral, posterior or 360-degree approaches. These include anterior lumbar interbody fusion (ALIF), transforaminal lumbar interbody fusion (TLIF), oblique lateral interbody fusion (OLIF), direct lateral interbody fusion (DLIF), posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF).
Dr Laban sees patients with all types of back pain related problems and conditions. If you are concerned about any symptoms you have, or if you want to get a second opinion, do contact us to book an appointment. At your initial consultation you will be able to discuss your problem with Dr Laban and, after appropriate investigation, he will offer tailor-made advice about the diagnosis and treatment options.