Lumbar Spondylolisthesis

Question 1

Definition

Answer 1

Occurs when one of the vertebrae in the spine slips out of place.
Occurs in 4%-6% of population

Always nearly L4 on L5 or L5 on S1

RF:
- athletes
- genetics
- age

prognosis:
- most of time, non surgical treatments can relieve symptoms
- for severe spondylolisthesis, surgical intervention is usually successful

Question 2

Clinical presentation

Answer 2

• Dysplastic spondylolisthesis 20%:
  – occurs in children
  – usually painless, may notice protruding abdomen
• lytic (isthmic) spondylolisthesis 50%:
  – most common
  – occurs in adults
  – intermittent backache
  – pain exacerbated by excercise or strain
  – a step can be felt running fingers down spine of pt
  – buttocks flat, sacrum extends to waist, and transverse loin creases may be prominent
• degenerative spondylolisthesis 25%:
  – occurs in adults 40+
  – caused by degeneration
  – long standing backache due to facet joint arthritis
  – spinal claudication can occur due to narrowing of the spinal canal (caudal equina)

Question 3

Grades of spondylolisthesis

Answer 3

Grade 1- <25% slippage

Grade 2- 25-50% slippage

Grade 3- 50-75% slippage

Grade 4- >75% slippage

Question 4

Investigations

Answer 4

X-ray:
– spinal x-ray helps to see if the vertebrae is out of place

CT scan or MRI:
– helps to see the spine in more detail if soft tissues are needed to be seen or discs or nerves

Question 5

Caused

Answer 5

causes:
- overextending of spine in young athletes
- genetics, as people may have thinner vertebrae
- in older people, degeneration causes spondylolisthesis
- can run in families
- can be caused by a tiny crack in a bone (stress fracture) more common in athletes and gymnasts

Question 6

Diagnosis

Answer 6

Pain in lower back, often worse when standing or walking and relieved when sitting or bending forward

Pain spreading to your bottom or thighs

Tight hamstrings

Pain, numbness or tingling spreading from your lower back down 1 leg (sciatica)

Does not always cause symptoms though

Question 7

Treatments

Answer 7

can be conservative and can be operative

Nonsurgical treatments:
– rest- from strenuous activities and sports
– medication- NSAID’s (ibuprofen or naproxen). if these dont work, other medications can be given.
– steroid injections right into the affected area (help reduce inflammation)
– physical therapy- targeted exercises to strengthen abdomen and back. often relieve pain after a few weeks
– bracing- a brace can help stabilise your spine.

Surgical treatments:
you may need surgery if you have high-grade spondylolisthesis.
– typically involves spinal decompression, with or without fusion.
—- studies show, fusion with decompression may give a better outcome than decompression alone.
—- for a fusion surgery, your surgeon fuses (connects) the 2 affected vertebrae. As they heal, they form into one bone, eliminating movement between the 2 vertebrae. You may experience some limited spinal flexibility as a result of the surgery.