What is spondylolisthesis?
Sliding vertebra (spondylolisthesis) in which a bone (vertebra) in the lower part of the spine slips out of the proper position onto the bone below it.
If this condition is not treated, the spine virtually gets instable. Additionally nerve roots might be compressed which will cause pain that radiates into the leg or other characteristic neurological symptoms.
Until then there is a chance that the patient doesn’t even realize that two of his vertebrae are out of line. Often enough increased work of the dorsal muscles can compensate for the impending instability. However sooner or later tenacious back pain will develop from the constant overwork of ligaments and muscles; visible changes in posture may occur.
- back pain that eventually radiates into the buttocks or the legs.
- pressure pain in the lower back (lumbar region)
- numbness or paresis in one leg
- a feeling of instability of the back
Sliding of vertebra can be inherent (isthmic spondylolisthesis) or acquired. Degenerative changes of the intervertebral space or the vertebral facet joints for example can cause spondylolisthesis.
Sport activities which involve a lot of back bending of the lumbar spine very often lead to damages of the vertebral arches. This can also contribute to the development of a spondylolisthesis. Other possible causes are traumatic injuries, some bone diseases or – in rare cases – undesired after-effects of certain spine surgeries.
In most of the cases spondylolisthesis is found in the lumbar spine region. Mainly it occurs between the penultimate (4.) and the last (5.) lumbar vertebra.
We offer different therapeutic options depending on the cause of slippage, concomitant diseases, age and symptoms of the patient !
- conservative treatment
In mild spondylolisthesis it may be sufficient to treat pain with analgesic drugs and to strengthen the back muscles with the aid of a targeted physiotherapy. Concomitantly thermal, manual or electrotherapy might help to relieve symptoms. In some cases the application of a tight plastic or cast corset is an additional option.
in younger patients with spondylolisthesis who suffer only from back pain, physiotherapeutic strengthening is the first line therapeutic option. If this does not control symptoms a stiffening surgery may be an appropriate solution. This might be done in certain circumstances solely with bone grafts - without screws or artificial implants.
- surgical treatment
If symptoms of spondylolisthesis cannot be controlled by conservative therapy or if there are neurological symptoms a surgery will be indicated. In many clinics a standard open procedure is offered for many cases of sipping vertebrae. This kind of surgery is done from the back (dorsal) or from the front (ventral) and is associated with a long recovery.
The APEX SPINE Center offers different individually adapted surgical treatments.
- if spondylolisthesis is stable (no further slippage with inclination or reclination) and leads to a narrowing of the spinal canal – an endoscopic enlargement of the canal will be sufficient (microscopic decompression).
- if spondylolisthesis is instable (functional imaging verifies further slippage with inclination or reclination movements) and comes along with spinal stenosis, additionally to microscopic decompression a fixation of the ligament is necessary.
- In younger patients with spondylolisthesis and unilateral neurological pain in most cases an endoscopic decompression is carried out.
- in younger patients with spondylolisthesis who suffer only from back pain, physiotherapeutic strengthening is the first line therapeutic option. If this does not control symptoms a stiffening surgery may be an appropriate solution. This might be done in certain circumstances solely with bone grafts - without screws or artificial implants.