Spondylolisthesis

Lintel, beams, and columns – you've probably heard of them. They are all crucial elements that maintain the building's structure straight. In a similar vein, the spine plays an essential role in maintaining the body's structure/posture straight. Comprising 24 bones known as vertebrae the spine serves as the body's main support structure. These bones are stacked on top of one another. The condition known as spondylolisthesis occurs when one of the vertebrae (bones) misaligns and begins to press down on the vertebrae beneath it.

Millions of people worldwide suffer from various forms of back pain and the World Health Organization (WHO) estimates that this number will only increase in the years to come. Spondylolisthesis is a major contributing factor to this number. Around 4-6 % of the population suffer from spondylolisthesis

Spondylolisthesis is more prone to develop in females and people aged over 50 are at higher risk of developing this condition. This misalignment can put pressure on the nerves causing back pain and other symptoms. Spondylolisthesis can occur in any part of the spine, however, it is most common in the lower spine, also people suffering from this condition can have no symptoms as the misalignment may not cause any pressure on the spine or nerves causing any pain.

Types of Spondylolisthesis

 

Some forms of spondylolisthesis develop with age while others are born with it. While some of these are highly prevalent and impact a sizable portion of the population while some are less frequent and arise from other causes. Different types of spondylolisthesis include,

Congenital Spondylolisthesis

This type of spondylolisthesis is caused by spinal deformities present during the birth. It is a condition when the spine or any part of it may not fully develop due to abnormal formation of the spine during fetal development.

Isthmic Spondylolisthesis

The breakage or fracture of the bone that connects the vertebrae together leads to isthmic spondylolisthesis. The breaking of the bony part of the vertebrae that connect the vertebrae (the pars interarticularis) causes misalignment of the spine leading to spondylolisthesis.

Degenerative Spondylolisthesis

The natural wear and tear of the disks that serve as cushions between the spine causes this type of spondylolisthesis which typically affects adults over 50. The degeneration increases the space between the vertebrae which raises the risk of slip-outs.

Traumatic Spondylolisthesis

This type of spondylolisthesis results from any serious injury or accident to the spine that leads to pushing the vertebrae out of place.

Post-surgical Spondylolisthesis

Any previous spinal surgery can cause this type of spondylolisthesis.

Causes of Spondylolisthesis

 

The underlying factors and type of spondylolisthesis can determine the cause. The following are some typical causes of spondylolisthesis.

Aging: As we age the disk and facet joints in our spine begin to crack & wear off due to natural wear and tear leading to instability and spondylolisthesis.

Pathologic Factors: These include diseases or conditions that weaken the vertebrae, including infections, tumours, osteoporosis, etc.

Trauma: Injury to the spine resulting in fracture or dislocation can cause slippage of the vertebrae causing spondylolisthesis.

Birth Defects: Defects like incompletely formed facet joints, or any abnormal formation of the spine is a key contributing factor leading to spondylolisthesis.

Additional causes of spondylolisthesis

include naturally thinner vertebrae than normal, sports injuries etc.

Risk Factors of Spondylolisthesis

 

Symptoms of Spondylolisthesis

 

The symptoms depend on the severity of spondylolisthesis, the extent of vertebral slippage, and the area of the spine that is affected. Some people might have severe pain while others might not have any pain or symptoms at all. Some of the common symptoms of spondylolisthesis include,

Lower Back Pain: The most common symptom of spondylolisthesis especially in the lower back, the pain may worsen with activity, particularly while waking, bending, etc.

Stiffness: Individuals suffering from spondylolisthesis, may experience reduced flexibility and stiffness in the lower back leading to difficulty with movements. 

Radiating Pain: The pain may radiate to the buttocks, thighs, and legs, caused by nerve compression or irritation.

Numbness or Tingling: The slippage of vertebrae can cause nerve compression resulting in the sensation of numbness or tingling in the legs or feet.

Difficulty Walking: Spondylolisthesis can cause pain or nerve issues while walking long distances.

Other symptoms include weakness in the legs, muscle tightness, bowel dysfunction, etc.

The symptoms vary depending upon the severity of the condition, i.e. individuals with mild issues may have minimal or no symptoms, while moderate to severe cases can significantly impact daily activities.

Diagnosis of Spondylolisthesis

 

A specialist can diagnose spondylolisthesis by performing a physical examination. Finding the painful area, and assessing the damage to the disk or nerves, etc can be aided by this physical examination. To determine the precise cause the specialist may also inquire about medical history, family medical history, pain areas etc. Post performing a physical examination the specialist may suggest certain imaging tests to determine the location, nature, and severity of the slippage. In order to diagnose spondylolisthesis, some imaging tests are frequently used including,

Spine X-ray: Provides a basic view of the vertebrae.
MRI: Gives a detailed image of the damage to the disks or nerves.
CT Scan: Helps create 2D images of the spine & provides a detailed view.

Treatment Options for Spondylolisthesis

 

The severity of the condition and the degree of vertebral slippage determine how spondylolisthesis is treated. The severity of the condition will determine whether non-surgical or surgical options are used for treatment. Based on the degree of a vertebral slip the National Institutes of Health (NIH) has classified spondylolisthesis into 5 different grades:

Grade I: Slippage of 1% to 25% of the vertebral body.
Grade II: Slippage of 26% to 50% of the vertebral body.
Grade III: Slippage of 51% to 75% of the vertebral body.
Grade IV:Slippage of 76% to 100% of the vertebral body.
Grade V: Complete slippage of the vertebra beyond 100%.

Grade I, II, and III are characterised as low-grade spondylolisthesis and can be treated with conservative treatment such as physical therapy, bracing, and medications. Grades IV and V are high-grade spondylolisthesis and require surgical intervention for treatment.

Non-surgical Treatment:

These entail using conservative methods to control the symptoms. Wearing a brace to stabilize the spine, taking over-the-counter medications to relieve pain and discomfort and regularly visiting a doctor to monitor changes are non-surgical treatments that are usually recommended for people with mild symptoms and low grade of spondylolisthesis. Physical therapy, alternate therapies, etc can also be used to help with strengthening the muscles and relieving stress.

Surgical Treatment:

Surgical treatments are recommended for individuals with more severe symptoms or high-grade spondylolisthesis. Surgery may be recommended to stabilise the spine or due to neurological compromise. Among the surgical techniques used to treat scoliosis are spinal fusion, spinal decompression, etc.

Prevention Strategies for Spondylolisthesis:

 

Prevention Strategy	Key Actions
Maintain Proper Posture	Sit and stand with a straight back
Strengthen Core Muscles	Perform core & back strengthening exercises
Avoid High-Impact Activities	Modify or limit sports like gymnastics, weightlifting, or repetitive heavy lifting.
Protect from Trauma	Use protective gear during sports; follow safety measures in daily activities.
Engage in Low-Impact Exercise	Activities like walking, swimming, and yoga to support spinal health.