Although the use of spinal instrumentation in skeletally immature patients is considered optional by some surgeons for some patients with isthmic-type spondylolisthesis, most spinal surgeons believe that rigid fixation is needed to achieve a solid fusion reliably. For degenerative-type slips, fixation has been shown to achieve higher rates of solid arthrodesis.
Dean et al studied 58 patients who underwent anterior cervical decompression and fusion, with an iliac crest structural graft, for degenerative spondylolisthesis from 1974 to 2003; they were evaluated for neurologic improvement and osseous fusion. The investigators found that the average neurologic improvement was 1.5 Nurick grades and that the overall fusion rate was 92%.[17, 18]
Unfortunately as the slip progresses it can pull on the nerves exiting the spinal canal causing pain, numbness and/or weakness. Pain due to mild or moderate spondylolisthesis is often misdiagnosed and may actually be coming from some other physical or psychoemotional source. In fact most patients who have a spondylolisthesis do not have any significant progression of spinal slippage. However, the brain can not tell exactly at what level nerve compression and dysfunction are occurring. Both feet feel as if they are on fire. Typically when there is forward slippage of one vertebra on another there is minimal affect on the nerves. I am ready for the fix but not the recovery its been 11 years since last one and I am now 60 and a bit scared but hoping to get back some kind of life to spend with my 2yr. It took almost a 3 weeks to recover from withdrawal symptoms. Do all cases of Spondylolisthesis progress? I have good bone growth and healing looks good. This sliding of one vertebra on another is called spondylolisthesis. In the few people where symptoms progress and pain or dysfunction becomes severe, some form of intervention may be necessary. Even though recovery is tough and takes time, I am glad I had the surgery.
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Before surgery is considered for adult patients presenting with degenerative spondylolisthesis, minimal neurologic signs, or mechanical back pain alone, conservative measures should be exhausted, and a thorough evaluation of social and psychological factors should be undertaken.
Spondylolisthesis may or may not be associated with gross instability of the spine. Some individuals remain asymptomatic even with high-grade slips, but most complain of some discomfort. It may cause any degree of symptoms, from minimal symptoms of occasional low back pain to incapacitating mechanical pain, radiculopathy from nerve root compression, and neurogenic claudication.
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.
Spondylolisthesis refers to the forward slippage of one vertebral body with respect to the one beneath it. This most commonly occurs at the lumbosacral junction with L5 slipping over S1, but it can occur at higher levels as well. It is classified on the basis of etiology into the following five types :
For more information on this topic, see Spondylolisthesis Imaging, Spondylolysis Imaging, Lumbar Spondylosis, Diagnosis and Management of Cervical Spondylosis, and Lumbosacral Spondylolysis.
The pars interarticularis, or isthmus, resists significant forces during normal motion. The pars may be congenitally defective (isthmic spondylolisthesis as spondylolysis) or may undergo repeated stress under hyperflexion and rotation that results in microfractures. Lumbar lordosis, gravity, posture, high-intensity activities (eg, gymnastics), and genetic factors all play a role in slip development. If a fibrous nonunion forms from an ongoing insult, elongation of the pars and progressive listhesis results; this is observed in another subtype of type 2 (isthmic) spondylolisthesis. In persons with spondylolysis, 30-50% are believed to progress to spondylolisthesis. The most common location is at L5-S1.
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.
Biomechanical factors are significant in the development of spondylolysis leading to spondylolisthesis. Gravitational and postural forces cause the greatest stress at the pars interarticularis. Both lumbar lordosis and rotational forces are also believed to play a role in the development of lytic pars defects and the fatigue of the pars in the young. An association exists between high levels of activity during childhood and the development of pars defects. Genetic factors also play a role.