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Lytic spondylolisthesis usually occurs at L5/S1 and normally presents in the teenage years or 20s. The classical example is the so-called fast (cricket) bowler’s “stress fracture”. It occurs due to repetitive stresses in the lumbar spine but it often appears with no obvious history of repetitive trauma.
Degenerative spondylolisthesis usually occurs in older women, most often at L4/5, but can occur at other levels. This type of slip is due to degeneration of the pair of facet joints between the two affected vertebrae. It is virtually never worse than grade 1.
Spondylolisthesis simply means the abnormal slip of one vertebra with respect to the vertebra immediately below. This is usually occurs forwards (anteriorly) of the upper vertebra, also known as anterolisthesis. Less common is a backwards (posterior) slip, also known as retrolisthesis. Much less common is a sideways (lateral) slip, called a laterolisthesis.
Nearly 80 percent of our spine patients are able to recover with nonsurgical treatment. But when physical therapy, medications, and spinal injections fail to relieve neck or back pain, we help patients with surgery.
First, athletic activity should be stopped to allow the fracture to heal. Conservative nonsurgical treatment is the first step and may include medication, rest, physical therapy, home exercises, hydrotherapy, a brace, and pain management. Periodic x-rays will allow the doctor to watch the degree of slippage. Surgery may be needed if slippage continues or if your pain is not relieved by conservative treatment.
Spondylolysis and spondylolisthesis are conditions affecting the joints that align the vertebrae one on top of the other. Spondylolysis is a weakness or stress fracture in the facet joint area. This weakness can cause the bones to slip forward out of normal position, called spondylolisthesis, and kink the spinal nerves. Treatment options include physical therapy to strengthen the muscles. A back brace may be used to support the spine. In some cases, surgery can realign and fuse the bones.
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