ABOUT
FOUR TYPES OF SPONDYLOLISTHESIS
Spondylolisthesis is a medical term referring to a slippage of one vertebral body over another. Typically, the fourth and fifth lumbar or the fifth lumbar and first sacral vertebral bodies are involved.
Spondylolisthesis is the most common cause of back pain in young adults but most cases are asymptomatic. Symptoms, if they do occur, often begin with a growth spurt, and its course can be slow, progressive and severe. Long asymptomatic periods are quite common.
Spondylolisthesis has several causes, including Isthmic spondylolisthesis, commonly caused by fatigue or a stress fracture of the pars interarticularis. Another cause is an acute (traumatic) fracture, and this type is more common to men and in about one of every two cases, there is no slip; additionally, the fracture may only be seen on five to 20 percent of lumbar spine x-rays.
A second type of spondylolisthesis is congenital spondylolisthesis (also called dysplastic spondylolisthesis). This type more commonly affects women, and again, symptoms usually occur during the growth spurt. Accounting for 14 to 21 percent of all spondylolisthesis cases, this type usually shows no defect in the pars interarticularis.
A third type of spondylolisthesis is degenerative spondylolisthesis. Degenerative spondylolisthesis is usually a result of long-term instability, and occurs most commonly at the junction of the fourth and fifth lumbar vertebrae. The instability results from a combination of disc degeneration and facet joint degeneration. Women ages 40+ are most commonly affected by degenerative spondylolisthesis.
Finally, a fourth type of spondylolisthesis is pathologic spondylolisthesis. This type often results from bone problems such as severe osteoporosis or bone tumors (usually metastatic). This type is the least common of all four types.
Pain is the most reported symptom of spondylolisthesis. Pain usually occurs at the onset of a growth spurt in adolescence and is the most common cause of back pain in the younger patient population. Exceptions to this include the degenerative, traumatic and pathologic types of spondylolisthesis. Pain is generally found in relation to activity, walking or prolonged standing. In such instances, the pain is located in the back, buttocks, thighs or calves, and improves with seated rest or lying down.
A patient’s description of his/her pain is extremely helpful in diagnosis, along with cultivating a thorough understanding of a patient’s medical history. MRI scans are incredibly helpful in understanding the degree to which a nerve has been compressed. In some cases, lumbar myelogram and post-myelographic CT scanning may also be needed to help define the actual problem. The myelogram and post-myelogram CT scan are particularly helpful in planning surgical treatment.
TREATMENT
The treatment of spondylolisthesis is complex and is contingent upon the signs and symptoms a patient presents. In adolescent cases of isthmic spondylolisthesis (spondylolysis), the x-ray and bone scan may help decide the type of treatment. If the bone scan is positive (“lights up”), a trial of bracing may be successful. Other forms of conservative treatment include rest and physical therapy.
If conservative treatment fails, surgical options are available. Click here for more treatment information >>