Spondylolisthesis is a condition where one vertebrae of your spinal column becomes displaced in reference to the vertebrae directly below it. Your spine is made up of 33 vertebrae that are stacked on top of one another to allow our nerves to travel down through the spinal column without any interference. In the case of spondylolisthesis, the translated vertebrae causes a narrowing of the pathway for the nerves passing through it, and can cause a variety of symptoms depending on the severity of the displacement.
SIGNS AND SYMPTOMS
It is important to note that most other orthopaedic spinal conditions share the same symptoms, so the presence of these symptoms does not predict the likelihood of spondylolisthesis.
- Low back pain and/or leg pain
- Numbness/tingling that radiates down either or both legs
- Hamstring tightness
- Muscle weakness in lower extremities, or possible muscle atrophy
- Pain brought up with prolonged standing, but not sitting
- Neurological impairments (ie. Diminished reflexes)
There are several causes that can result in spondylolisthesis so it is important to determine the cause of the condition so your treatment plan can be customized for your specific needs. Below are general classifications of spondylolisthesis.
Isthmic Spondylolisthesis: A slow developing fracture/defect at the pars interarticularis sight which causes the vertebral body to slide forward without the support of the back half of the vertebrae. This type of spondylolisthesis typically occurs in the younger population.
Degenerative Spondylolisthesis: Typically occurs at the L3-L4 level, or L4-L5 level of the spine due to weak bones, and ligaments from aging (typically over the age of 50).
Other: In other cases, spondylolisthesis can be caused by a traumatic event in which another part of the vertebrae is fractured causing displacement of the vertebrae, it can be a side effect from a laminectomy, or it can even be a congenital condition as some people are born with elongated pars interarticularis.
Risk factors that may also raise your chances of having spondylolisthesis include:
- Female gender
- Older age
- Excessive hyperextension of spine (as in gymnastics participation)
- Generalized hypermobility of joints and soft tissues
- Anatomical predisposition
A history along with a physical examination is typically the first step to find any indication of spondylolisthesis. A noticeable depression on palpation may be present during the physical examination. It is very likely that imaging techniques such as an X-ray, a CT scan, or an MRI will be ordered to confirm the diagnoses, and to rule out any other conditions.
The presence of a spondylolisthesis on a static x-ray is not sufficient to assume that it is the cause of the patient’s pain. Flexion and extension views of the spine in standing can discover if the spinal segment is in fact hypermobile. This, coupled with a subjective history suggestive of spinal instability is reasonably accurate.
Physiotherapists have been shown to help with management of spondylolisthesis. Consulting with your physiotherapist, and coming up with a treatment plan that is specific to your needs is vital to the process.
Exercise therapy is one of the main strategies used to help manage pain, and prevent further translation of the vertebrae. These exercises can include stretching, posture education, and strength exercises to help stabilize the area, reduce pain, and reduce risk of further damage.
Activity limitations will be suggested to help you find alternatives to daily activities that are aggravating the condition. Introducing rests periods in a position of comfort into daily routines will help reduce pain and encourage healing.
Passive treatments where you allow the physiotherapist to perform treatment techniques or modalities can be done to manage pain, or relieve muscle spasm. Manual therapy such as massage can be done to help with chronic muscle spasms, or tension that has been building up from the chronic condition. Heat and cold therapies may further reduce pain in the low back.
If the condition is severe, surgery may be recommended. Physiotherapy treatment will be required before and after surgery.
Outcomes for patients with only spondylolisthesis are typically very good. Patients report short- and long-term relief with participation in an appropriate physiotherapy program.
Spondylolisthesis is a challenging condition that is best managed if caught in its early stages. It can cause very severe symptoms if left unattended. It is recommended that you seek out a physiotherapist to perform an assessment if you feel that your symptoms may be linked to spondylolisthesis. Assessment of your symptoms to discover the root cause of the condition will allow for better management, and prevention of further damage to your body. Intervention is not reserved for when symptoms are at their worst. Often the best time to treat this condition is when you are feeling good. This way you can perform strengthening exercises at an intensity that will have a positive impact on your overall spinal stability without suffering an increase in symptoms