Spondylolisthesis
Dec 2009
Fancy Name, Common Problem
Did you know that back pain and leg pain lead about 20 percent of Americans to see a physician each year? Although most back pain is minor and usually resolves on its own, there are many different problems that can cause lingering lower back pain. About 10 percent of patients who see an orthopaedic spine specialist for their back pain have spondylolisthesis—a condition where the bones in the spine (vertebrae) have either slipped or shifted.
Vertebrae may slide or change position for many reasons. The most common culprit is degenerative disc disease, which causes the vertebrae to sit more loosely on each other and allows them to shift. The vertebrae may also fail to connect completely in childhood, allowing the bones to slip away from each other. In adolescents, back pain may start as the bones start to shift. As the child becomes more active in sports, the spinal instability caused by a poor vertebral connection will become painful. X-rays may show a break in the bones; however, some kids who are experiencing back pain will have normal-looking X-rays. Further evaluation with a CT scan can help the physician more closely examine the spine. Some people live their entire lives with a break in their vertebrae and do not experience back pain until their discs, pads that separate each spinal bone, start to degenerate.
Disc degeneration can be painful; as the spine continues to degenerate and vertebrae slip, the spinal nerves endure more and more pressure.
In most cases, spondylolisthesis is diagnosed in middle age and is the result of degeneration in the spinal discs. As the discs degenerate, they cannot support the weight of the spine, which allows the bones to shift. As bones shift out of normal position, the discs have to bear the brunt of the patient’s body weight and movement, which, in turn, applies more stress to the discs and causes them to degenerate faster.
Most patients with mild spondylolisthesis will not have any worse back or leg pain than most people their age and won’t have to stop any normal activities. However, as these individuals age, the discs between the slipped vertebrae degenerate further. Disc degeneration can be painful; as the spine continues to degenerate and vertebrae slip, the spinal nerves that are protected by the bones endure more and more pressure. Pinched nerves cause pain in the nerve roots, which is felt in the back of the legs and down to the foot—a condition called sciatica, often confused with leg pain.
The initial treatment for low-back and leg pain related to spondylolisthesis is a physical therapy program and anti-inflammatory medications. Exercise, stretching, spinal traction and manual therapies (like massage and spinal adjustments) can help reduce the pain. The goal of treatment is to relieve the pressure on the nerve and mobilize the bones and discs to allow for a more fluid motion of the back without irritating the muscles, tendons or nerves. Most patients respond well to this treatment and can maintain their spinal health with a home exercise program. If medication and holistic approaches are unsuccessful, steroid injections around the nerves and joints may help relieve some of the acute pain. If all of these treatments don’t work, surgery is an option. Although most people are reluctant to have back surgery, improved techniques have made surgery for spondylolisthesis a very effective procedure.