The cause of Spondylolytic Spondylolisthesis may centre upon the congenital orientation of the facet joints. If they are set in such a way that they are overloaded then whilst the bones are still soft in childhood, the supporting bone will fracture. Because the load persists and continuous movement takes place between the bone ends the fracture fails to heal leaving a defect held together by cartilage and fibrous scar. In later life either as a teenager or often in mid life, the disc degenerates the internal mass of the disc breaks up and leaves the body, the disc shrinks and looses height. The disc wall becomes slack and the vertebrae become freer to slide around and overriding increases. Here the facet joints have been separated from continuity with the vertebral body and can no longer control the direction or extent of travel and the unhealed fracture stretches and the boundaries of the exit canal (Foramen) consisting of the disc and overriding facets of the facet joint and fracture site, distort. The slippage usually arrests at an override of 50% in midlife presentations but in teenagers slippage can exceed 100%.
As the disc degenerates the internal mass of the disc breaks up and leaves the body, the disc shrinks and looses height. The disc wall becomes slack and the vertebrae become freer to slide around. The direction of slide is controlled by the orientation of the facet joints behind and ligaments and muscles attached to the vertebrae. As the capsule of the facet joint stretches so the travel of slippage increases, the wall of the disc distorts and stretches and the boundaries of the exit canal (Foramen) consisting of the disc and overriding facets of the facet joint, distort. The slippage is arrested at a maximum override of 50%.
is the term used to define a degenerative and an acute spine condition in which a single vertebra gets displaced and moves backwards onto the vertebra lying immediately below it. Vertebrae are the bones that make up the spinal column and are separated from each other by cushioning intervertebral discs.
Retrolisthesis and joint dysfunction of one or more lumbar vertebra may result in lower back pain and referred pain that extends to the foot.
To treat your condition, your doctor may recommend:If manipulation training or manipulation adjustments does not result in significant relief of your symptoms, your doctor may prescribe additional tests and consultation with a spine specialist to see if nerve root compression (pinched nerve) is accounting for your back pain and radiating pain to your hands or feet.
As the disc degenerates the internal mass of the disc breaks up and leaves the body, the disc shrinks and looses height. The disc wall becomes slack and the vertebrae become freer to slide around. In this situation the slide takes place in a backwards direction. This slide is in the main controlled by the orientation of the facet joints behind and ligaments and muscles attached to the vertebrae but the backwards direction may be directed by the natural overarching posture of the patient. As the capsule of the facet joint stretches so the travel of slippage increases, the wall of the disc distorts and stretches and the boundaries of the exit canal (Foramen) consisting of the disc and overriding facets of the facet joint, distort. The slippage usually arrests at an override of 5mm.
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Unfortunately the patient may present with degeneration at more than one disc level. Until the advent of aware state surgical examination, the sources of Vertebral Slippage were hard to define and surgeons engaged in pre-operative ‘guesstimation’ based on the results of clinical examination, X-rays, MRI scans and CAT scans. The complexity of the spinal region means that a wide range of possible conditions exist to confound diagnosis. In the presence of back and leg pain and spondylolisthesis or retrolisthesis the surgeon will tend to focus upon this evident pathology and treat this. In our published studies the pain was arising at an adjacent level in almost 20% of cases. The patients body had adapted to the slippage and surgery at this level would not have modified the pain.