Diagnosis is made based on clinical symptoms, clinical examination and a cervical spine MRI scan, CT scan, or both.
Initial treatment is conservative (non-surgical), in the form of analgesics, physiotherapy and cortisone injections.
Disc rupture can be caused by trauma, the normal degenerative ageing process, or both.
Diagnosis is made based on clinical symptoms, clinical examination and is confirmed by CT and MRI scans of the lumbar spine.
80% of patients with disc prolapse will improve with conservative (non-surgical) treatment in the form of analgesics, physiotherapy, perineural cortisone injections and time.
Depending upon the cause of the spondylolisthesis, the condition may or may not be avoidable. If it is due to a congenital gap in the bone (pars interarticularis), then there is not much that one can do to prevent the eventual effects of normal strain on the spine and gravity from causing a slip to develop. Certainly being at an ideal body weight, staying in shape, exercising and keeping the back and abdominal muscles strong will help to decrease the likelihood of slip over time. Similarly, when the slip is due to degeneration and aging of the facet joints, there is not much that one can do except to try to keep close to an ideal body weight and stay in shape. On the other hand, there are certain exercises which have a higher risk of causing a fracture of the pars interarticularis, thus resulting in the possibility of spondylolisthesis in the future. Certain athletic activities which cause extension of the spine (standing and arching the back backwards) predispose one to such fractures, such as gymnastics and diving. However, they are uncommon in swimmers.
Surgical intervention may be needed when, patients fail to respond to nonsurgical treatments, there is progression of the slippage over 30%, the slip is grade III or higher, or when there are progressive neurological symptoms and physical deformity.
Spondylolisthesis may cause the patient to have pain in the back or in the neck as a result of the slip of the bones themselves. The patient may also experience radicular pain to the arms or legs if the nerves are being pressed as they leave the neural foramen. The patient may also experience a more generalized pain to the lower extremities if there is significant compression upon the nerves in the central canal. In the neck, a significant spondylolisthesis may cause pressure on the spinal cord itself, resulting in pain and paralysis.
In general, the prognosis for these patients is quite good when the slip is of a lower grade. When the spondylolisthesis is of grade III or higher, the risks of injury to the nerves during surgery and experiencing further slipping of the spine in the future is higher than in the lower grade slips.