A condition called can also cause the slippage that happens with spondylolisthesis. Spondylolysis is a defect in the bony ring of the spinal column. It affects the pars interarticularis, mentioned above. This defect is most commonly thought to be a "stress fracture" that happens from repeated strains on the bony ring. Participants in gymnastics and football commonly suffer these strains. Spondylolysis can lead to the spine slippage of spondylolisthesis when a fracture occurs on both sides of the bony ring. The back section of the bony ring separates from the main vertebral body, so the injured vertebra is no longer connected by bone to the one below it. In this situation, the facet joints can't provide their normal support. The vertebra on top is then free to slip forward over the one below.
Degenerative changes in the spine (those from wear and tear) can also lead to spondylolisthesis. The spine ages and wears over time, much like hair turns gray. These changes affect the structures that normally support healthy spine alignment. Degeneration in the disc and facet joints of a spinal segment causes the vertebrae to move more than they should. The segment becomes loose, and the added movement takes a additional toll on the structures of the spine. The disc weakens, pressing the facet joints together. Eventually, the support from the facet joints becomes ineffective, and the top vertebra slides forward. Spondylolisthesis from degeneration usually affects people over 40 years old. It mainly involves slippage of L4 over L5.
Spondylolisthesis is the actual slipping forward of the vertebral body (the term "listhesis" means "to slip forward") (Fig. 3). It occurs when the pars interarticularis separates and allows the vertebral body to move forward out of position causing pinched nerves and pain. Spondylolisthesis usually occurs between the fourth and fifth lumber vertebra or at the last lumbar vertebra and the sacrum. This is where your spine curves into its most pronounced "S" shape and where the stress is heaviest.
Mild cases of spondylolysis and spondylolisthesis usually cause minimal pain. In fact, the conditions are often found by accident when a person has a pre-employment exam or an X-ray of the back for an unrelated reason.
Spondylolysis (spon-dee-low-lye-sis) and spondylolisthesis (spon-dee-low-lis-thee-sis) are separate, yet related conditions. Spondylolysis usually comes first, though not always. The term comes from "spondylo," which means "spine," and "lysis," which means to divide. Spondylolysis is a breakdown or fracture of the narrow bridge between the upper and lower facets, called the pars interarticularis. It can occur on one side (unilateral) or both sides (bilateral) and at any level of the spine, but most often at the fourth or fifth lumbar vertebra (Fig. 2). If spondylolysis is present, then you have the potential to develop spondylolisthesis.
Common spondylolisthesis surgery involves a of the lumbar vertebra and the sacrum. A spinal fusion uses minimally invasive techniques to join two or more vertebrae of the spine. Once healed, this fusion eliminates the pain caused by abnormal motion within the vertebrae themselves. In some cases rods and/or screws are used to hold the vertebra in place during the healing process.
An ache in the low back and buttock areas is the most common complaint in patients with spondylolisthesis. Pain is usually worse when bending backward and may be eased by bending the spine forward.
Your doctor may also order an (magnetic resonance imaging scan). The MRI machine uses magnetic waves rather than X-rays to show the soft tissues of the body. It can help in the diagnosis of spondylolisthesis. It can also provide information about the health of nerves and other soft tissues.
Nonsurgical treatment for spondylolisthesis commonly involves physical therapy. Your doctor may recommend that you work with a physical therapist a few times each week for four to six weeks. In some cases, patients may need a few additional weeks of care.
In younger patients (under twenty years old), spondylolisthesis usually involves slippage of the fifth lumbar vertebra over the top of the sacrum. There are several reasons for this. First, the connection of L5 and the sacrum forms an angle that is tilted slightly forward, mainly because the top of the sacrum slopes forward. Second, the slight inward curve of the lumbar spine creates an additional forward tilt where L5 meets the sacrum. Finally, gravity attempts to pull L5 in a forward direction.
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.
When spondylolysis and spondylolisthesis do cause pain, you may experience low back pain, stiffness, and muscle spasms. You may also have sciatica (pain radiating down one or both legs), or numbness, though this is not common. Leg pain will usually be worse when you stand or walk.
Dr. LaGrone treats all areas of spinal pathology of the cervical, thoracic and lumber spine including: Scoliosis, Flatback, Kyphosis, Congenital Spine Deformities, Spondylolisthesis, Herniated Disc, Revision Surgery and Back Pain.
Spondylolisthesis is most often caused by spondylolysis. The cause of spondylolysis is not as clearly defined. Most believe it is due to a genetic weakness of the pars interarticularis. Both spondylolysis and spondylolisthesis can be present at birth or occur through injury. Repeated stress fractures caused by hyperextension of the back (as in gymnastics and football) and traumatic fractures are also causes. The most common cause in adults is degenerative arthritis.