Multiple Sclerosis Sufferers may present with various combinations of back, buttock and leg pain, numbness and muscle weakness, Symptoms are often aggravated by an abnormal asymmetrical gait arising from loss of spatial awareness, loss of limb control and numbness in the feet. The back pain may arise from irritation within the disc wall but more commonly arises from the pinching of the trapped nerve in the exit doorway (Foramen) from the spinal column. The foramen may be distorted and the nerve is tethered by years of scarring reaction to repetitive bruising, can not evade the pinching by the bulging distorted disc wall or overriding facet joints (or fracture margins in the case of Spondylolytic Spondylolisthesis). The disc may be degenerate and bulging and contribute to the irritation of the tethered nerve. When advanced the compression causes numbness and weakness to develop. The patchy weakness of the muscles controlling the spinal segments results in asymmetrical loss of control of the disc levels and aggravation of the effects of the local pathology at each level and aggravation of symptoms arising at these levels.
For posterior spinal decompression surgery to aggravate Spondylolysis or Spondylolisthesis, signs/symptoms of Spondylolysis or Spondylolisthesis should occur within 10 years of the surgery.
Signs/symptoms of Spondylolisthesis and/or Spondylolysis at the time of the repetitive trauma, or within 2 to 3 days of cessation of the trauma;
There may be no objective signs in Spondylolysis, or in first or second degree Spondylolisthesis. The finding of Spondylolysis on x-ray in an adult is likely to be incidental, and not the cause of back pain if that pain did not commence in childhood or adolescence. Tightened hamstrings are present in the majority of those who are symptomatic. Tenderness and spasms of the paravertebral muscles may be present at the level of the vertebral defect and surrounding segments. Pain may be induced and increased by certain movements.
In Spondylolysis, symptoms are often absent. Defects are then discovered only incidentally on x-ray made for other purposes. In Spondylolisthesis, injury may aggravate (permanently worsen) any symptoms, but rarely does a single injury cause symptoms in a person who previously had none. Symptoms generally begin insidiously during the second or third decade as an intermittent dull ache in the lower back, present with increasing frequency during walking and standing. Later, pain may develop in the buttocks and thighs, and still later unilateral sciatica may develop.
Spondylolysis and Spondylolisthesis usually cause no symptoms in children; however, many seek medical evaluation because of a postural deformity or gait abnormality. Pain most often occurs during the adolescent growth spurt and is predominantly backache, with only occasional leg pain. Symptoms are exacerbated by high activity levels or competitive sports and are diminished by activity restriction and rest. The back pain probably results from instability of the affected segment, and the leg pain is usually related to irritation of the L5 nerve root.
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.
Most spondylolytic defects and cases of Spondylolisthesis are congenital. The prevalence of Spondylolisthesis in the general population is about 5% and is about equal in men and women. Spondylolysis and Spondylolisthesis most frequently involve L5, although L4 can also be affected and, rarely, more proximal levels.