Spondylolisthesis is the term used to describe the slipping of one vertebrae off of another. In the spine, each vertebrae sits on top of another with a disc in between. The floor on which these vertebra sit is tilted, providing your spine with its natural curve. In the normal spine, there are a number of restraints which prevent one bone from sliding off of the one below. In front of the spine, there is the disc and its attachments from one bone to the other. In the back of the spine, there are the facet joints and the supports of these joints (pars interarticularis), which provide stabilization.
Sometimes because of genetics, trauma, arthritis, and/or past surgery, these stabilizers of the spine no longer function. Once they give way, gravity slowly begins to pull one bone down the slope off of the other.
This can bring about pain from two different causes. First, the abnormal motion of one bone on another can cause movement associated with back pain and muscle spasm. Secondly, as the bones move on one another, the nerves, which pass around and through the spine, can become compressed. This is usually felt in your legs as pain, cramping, and weakness.
What Treatments Exist?
There are several treatments for Spondylolisthesis. The choice of treatment depends on many factors. Some include your age, the amount of slipping that has occurred, and the amount of pain you are experiencing. These treatments usually combine the following methods:
Exercise: Exercise which strengthens your back and stomach muscles, done along with instruction on posture and movement, has been shown to be very effective in the treatment of Spondylolisthesis. With good strength and proper body mechanics, you can decrease the amount of slipping one bone does on another. Basically, you use the muscles under your control to make up for the failure of natural restraints. This can often relieve pain and slow the slipping process, giving the body a chance to heal.
Non-steroidal, Anti-inflammatory Medications: These medications (ie: Ibuprofen, Relafen, Lodine, Voltaren, Naprosyn, DayPro, etc.) can decrease pain and inflammation. Taken along with an exercise program, they can significantly relieve your pain. Patients may react differently to each of these medications. Often patients need to try several before the best one is found. Some new medications only need to be taken once or twice a day and are easier on your stomach. These medications do not cure the problem; rather they allow you to function in spite of it.
Epidural Steroids: You may be given an injection of a steroid around the nerves, which are being squeezed. A steroid is the most powerful anti-inflammatory medication. Through this injection, a small amount of the most powerful medication is inserted exactly where your problem occurs. An x-ray machine is utilized to easily place the medication on the exact location. While this does not “cure” the problem, it can quickly calm it down, occasionally for many months. Often, when combined with a therapy program, this improvement can be nearly permanent. If needed, these injections can be repeated periodically.
Surgery: This is the last resort for Spondylolisthesis and the only method to directly take the pressure off the nerve. The operation for Spondylolisthesis usually consists of two parts. The first part consists of a decompression, where pressure is taken off the nerves by removing the bone and soft tissue which is pressing on them. In the second part of the operation, a fusion is done. This stops the slipping process. Basically, the bones are fooled into thinking they were broken and encouraged to heal together. This sometimes requires the use of bone graft taken from your iliac crest, as well as screws and rods to hold the bones still while they heal. Hospitalization after surgery can last three to seven days. The operation is individualized depending on the particular patient’s problem. You should ask your surgeon about your operation, and what will be required for you.