Spondylolisthesis refers to a slip of one vertebrae relative to another. The most common causes include degeneration in the disc and facet joints or a stress fracture. The lower lumbar levels are most commonly involved. The slippage can cause back pain or sciatica symptoms. Treatments include anti-inflammatory medication, physical therapy, injections or surgery. The surgical treatment of a spondylolisthesis usually requires a fusion and laminectomy. At Redwood Orthopaedic Surgery Associates in Santa Rosa, CA we specialize in diagnosing and treating lumbar spondylolisthesis.
What is lumbar spondylolisthesis?
Spondylolisthesis is a condition involving spine instability. In these cases, a vertebra slips out of place onto the vertebra below. This can place pressure on a nerve, which will show itself in the areas served by the nerve, such as the lower back or leg.
“Spondylolisthesis” originates from a combination of the Greek words “spondylos,” which means spine or vertebra, and “listhesis,” which means slipping, sliding, or movement.
How is spondylolisthesis different from spondylolysis?
While both conditions cause lower back pain, spondylolysis involves stress fractures or cracks in the vertebrae. Spondylolisthesis is where the vertebra slips out of place. Spondylolysis is common in young athletes, especially gymnasts, and it can lead to the slippage of spondylolisthesis.
How serious is lumbar spondylolisthesis?
High-grade spondylolisthesis is quite serious, as the patient will have severe pain that is impacting a nerve. It’s important to stabilize the spine where the vertebra has slipped out of alignment. This condition won’t reverse or improve on its own, although you can achieve pain relief without surgery.
How common is lumbar spondylolisthesis?
Lumbar spondylolisthesis occurs in somewhere around 4 to 6 percent of the adult population. In some lucky patients they can live with the condition and not know it, as they don’t experience any symptoms.
Degenerative spondylolisthesis due to aging and the wear and tear of osteoarthritis is more common after the age of 50. This is more common with women than men.
“Everyone was very helpful and accommodating. Dr. Irzza very thoroughly answered all of my questions and gave me good advice as well as explaining all of my options. His help made me very comfortable in making the decision regarding the option I chose.” -Kim R.
What are the treatment options for lumbar spondylolisthesis?
When trying to get past the pain of spondylolisthesis, it’s important to work with spine specialists, such as the team at Redwood Orthopaedic Surgery Associates. Spinal problems and the corresponding pain aren’t the places for home remedies and YouTube videos. To keep your situation from further degrading the quality of your life, you want the highest level of expertise and experience.
How spondylolisthesis is treated depends on the grade of your slippage, your symptoms, age, and overall health. At Redwood Orthopaedic Surgery Associates, our first course of treatment in all cases not involving trauma is to exhaust nonsurgical options. For spondylolisthesis, these are the nonsurgical treatment options:
- Rest — Avoid sports, strenuous exercise or lifting, and other activities that place pressure on your lower back.
- Medication — Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can provide pain relief, as can prescription medications (although they cannot be used long-term).
- Corticosteroid injections — Steroid injections into the area of the compressed nerve can provide pain relief for months by decreasing inflammation. Again, however, they are not long-term alternatives.
- Physical therapy — Physical therapy involving targeted exercises to strengthen your abdomen and back can be effective. Over time, these can create the support necessary to lessen or remove the pressure on the nerve.
- Bracing — Bracing can help stabilize the spine, but it is only used in children and teens.
Surgery for the back and leg pain due to lumbar spondylolisthesis typically involves spinal decompression, with or without fusion. Surgery is always the last option, only considered when conservative treatment options have been exhausted. If the patient’s vertebra continues to slip, or if the pain is not relieved and begins to really impact life, surgery may be necessary. The main goals of lumbar spondylolisthesis surgery are to relieve pain associated with the irritated nerve, to stabilize the spine in the area of the slipped vertebra, and to return or improve function.
There are generally two procedures that our Redwood Orthopaedic spine surgeons would use. A laminectomy involves removing the lamina on the back of the vertebra and opening space for the nerve root exiting the spinal column. The goal is to remove the point of compression on the nerve. This can create extra instability in the vertebra, however.
Spinal fusion fuses the slipping vertebra to the vertebra either above or below it. The two vertebrae are fused into a single piece. This eliminates the movement that is impinging on the nerves in the area.
What is recovery like after surgery to address lumbar spondylolisthesis?
If you have a laminectomy, you may be able to return to desk work or light activity possibly as soon as a few days to a couple of weeks. But you can’t lift anything over five pounds for a period of time that we will discuss with you. Strenuous occupations will require much more time off. If you’ve had spinal fusion, your recovery is much more involved, as the two vertebrae need to be able to grow together. All pressure on the spine needs to be avoided. Full recovery from fusion surgery can take up to eight months. Recovery from possible back surgery is quite variable by the method used and depending on how much nerve impingement the patient has, so it is very difficult to give a recovery timetable beforehand. As we get a better idea of your lumbar spondylolisthesis and how we want to address it, we can give you much more specific recovery prognosis.
What happens if I don’t treat my lumbar spondylolisthesis?
As mentioned above, some patients don’t have any symptoms and don’t even know they have this condition. But pain will usually develop at some point. It is important to treat the condition. If left untreated, lumbar spondylolisthesis can create two problems with the spine — lordosis (swayback) or kyphosis (roundback). If a nerve is impinged, the pressure can eventually lead to permanent nerve damage, which will lead to weakness and leg paralysis.
Schedule a client consultation
Redwood Orthopaedic Surgery Associates proudly provides patients from Santa Rosa, CA and surrounding areas with treatment for lumbar spondylolisthesis. Contact us at (707) 544-3400 or fill out a Contact Form here.