It is thought that athletic activities that require repeated hyperextension and rotation or repetitive combined flexion-extension predisposes athletes to develop pars defects. There are multiple types of spondylolisthesis and the exact cause is unknown.Isthmic and degenerative are the two types that are most common in adults. The three other types include traumatic, pathological, and dysplastic. The case study patient was a Lytic spondylolisthesis, which is always due to a fatigue fracture and is commonly seen in patients less than 50 years old.Overall, as the vertebral body slips forward there is narrowing of the spinal canal and intervertebral foramen which results in stenosis. As stenosis occurs the typical presentation changes from one of back pain to one that includes radicular symptoms. The typical clinical presentation of a spondylolisthesis is pain generally localized in the lumbar paraspinals, gluteals, and posterior aspects of the thighs. The symptoms usually increase with standing or walking. As the slippage progresses there is typically more irritation of the nerve root and the hamstrings become tight. This may be of benefit to a patient because of the hamstring insertion into the ischial tuberosities which would support a posterior pelvic tilt and subsequently decrease lumbar lordosis. Patients tend to walk in a more flexed position and develop increased hip flexor muscle tension. Flattening of the sacrum can be seen as the patient attempts to stop the slippage.Diagnosis usually occurs by radiographs and the slip can be graded by the Meyerding’s system. In this system a Grade I is up to 25% displacement, Grade II 50%, Grade III 75%, Grade IV 100%, and Grade V greater than 100% displacement.It has been found that only 10-15% of these patients go on to have spinal surgery and that most improve with nonoperative treatment. Typical nonoperative care includes rest, NSAIDS, ESIs, and a physical therapy program. Clinical significant improvements have been found with interventions that included lumbar flexion exercises and walking, but even more substantial improvement was found with the addition of manual therapy (joint mobilization and manual stretching) when performed to the lumbar spine and lower extremities.
The typical pattern of presentation in the teenager at risk is dull, symmetrical low back pain without radiation to the lower limbs (although buttock pain is common) that is worst during and after exercise particularly involving hyperextension. Rest usually eases it. Examination findings can vary from normality to slight lumbar stiffness and discomfort when extending the low back, although in the acute phase when the pain is severe marked muscle spasm and hamstring tightness is often present. When there is no spondylolisthesis neurological examination is usually normal .
Ayurvedic treatment is very popular for treatment of many types of back problems and adult Isthmic spondylolisthesis is no exception. Ayurvedic medications and oil applications are very effective when used for a period of time in relieving the pain and other symptoms without the need for pain killers. Persons who have, pinched nerves leading to pain spreading to the legs or numbness in the legs due to the nerves getting involved, may require more intense Ayurvedic therapies with rest or with physical therapy and stabilization to overcome the problems. In almost all cases it is possible to avoid surgery with Ayurvedic treatment by experienced Ayurvedic physicians.
Surgical treatment is recommended only to those patients whose condition has either not improved or worsened is spite of non-surgical treatment. If a spine nerve has been compressed in cases, a surgery helps in reopening a tunnel or way for the nerve to move freely. Fusion may also be suggested to avoid further slippage. Fusion surgeries have a success rate of about 75% in relieving symptoms of isthmic spondylolisthesis.
In most cases Adult Isthmic Spondylolysis or Spondylolisthesis does not require surgery as the L5 vertebra is protected by strong ligaments. For a long period of time this condition is asymptomatic and when the pain begins to manifest, the doctor may recommend complete rest to ease the pain. Non-surgical treatment by Orthopedics may also include anti-inflammatory medication, analgesic drugs either orally or through injections. This will help reduce the pain, swelling and support the patient to perform daily activities without any hindrance. Braces may also be recommended for stabilization. Physical therapy may be advised to improve flexibility and strength. Yoga is becoming extremely popular for strengthening of the back muscles after the rest periods.
How is Grade 1 Spondylolisthesis Diagnosed and Treated?
The best way to confirm a diagnosis of grade 1 spondylolisthesis is through MRI and CT scans. These images allow your doctor to see the exact position of the slipped disc and the degree of slippage so far. Physical therapy is usually the first step toward managing symptoms of grade 1 spondylolisthesis. However, if this method fails to control pain, surgical treatment may be the best option.
Grade 1 spondylolisthesis can happen as the result of injury at any age, but it usually arises gradually in older adults. As the spinal discs undergo wear and tear, they may become dried out and compressed. This compression of the spine can cause the vertebrae to overlap one another, while the disc itself may protrude into the spinal canal, pinching nerves.
Grade 1 spondylolisthesis, or a slipped disc, is a spinal condition that can be very painful. When one vertebra slips forward over the other, the result is uncomfortable friction exacerbated by motion. While pain is sometimes confined to the area of slippage, a slipped disc can also put pressure on adjacent nerve roots, causing numbness, tingling, and/or weakness in the extremities.
Klein G, Mehlman CT, McCarty M. Nonoperative treatment of spondylolysis and grade I spondylolisthesis in children and young adults: a meta-analysis of observational studies.. J Pediatr Orthop. 2009 Mar;29(2):146-56.