What is Spondylolisthesis??
This back condition occurs when a vertebra slips forward or backward. This occurrence can lead to a deformity of the spine and create narrowing of the spinal canal (central stenosis) or compression of the exiting spinal nerve roots (foraminal stenosis).
- Congenital or Dysplastic Spondylolisthesis – a defect in the formation of the facet joint that allows it to slip forward.
- Isthmic Spondylolisthesis – defect or small break in portion of the vertebra called the “Pars Interarticularis” in which repetitive trauma common to athletes exposed to hyperextension movements such as in gymnastics and football players.
- Degenerative Spondylolisthesis – due to arthritic changes in the vertebral joints and cartilage diminishment.
- Traumatic Spondylolisthesis – direct trauma or injury to the lower back causing fracture of the back portion of the vertebra causing forward slippage of the front portion.
- Pathologic Spondylolisthesis – A defect in the bone from any abnormality such as a tumor process.
The most common symptom of spondylolisthesis is lower back pain. Typically, it worsens during or after exercise and especially with extension movements. Tightness of the hamstrings and reduced range of motion of the lower back are common as well. Lumbar muscle spasms are commonly found with this condition. Numbness, tingling, weakness and/or pain in the leg/legs due to nerve compression is common as well.
Spondylolisthesis is typically identified following interactive examination, symptom profile and history of occurrence but nailed down with pain film x-rays (lateral and oblique views) to allow visualization of the lumbar vertebrae and if there is slippage and/or a pars defect (fracture). If slippage is present, it is graded on degree of such with respect to the neighboring vertebra.
- Grade 1 is a slip of up to 25%
- Grade 2 is between 26-50%
- Grade 3 is between 51-75%
- Ggrade 4 is between 76-100%
- Grade 5 or Spondyloptosis occurs when the vertebra has completely fallen off the adjacent vertebra.
If grade 2 or above is discovered, lower extremity symptoms such as numbness, tingling, weakness and/or pain may occur and warrant further studies such as CT and/or MRI and referral for orthopedic/neurosurgical evaluation.
Management of Spondylolisthesis:
For most cases that are not in the Grgade 4 and/or 5 stage, conservative management can support this pathology. In the acute phase, avoidance is critical to allow for the inflammation, spasms and pain to subside. Ice, physiotherapy (Electrical stimulation/Interferential current therapy, Iontophoresis, bracing and passive stretching) are warranted. Once the acute phase is calmed down, active rehabilitation is recommended with myofascial release therapy, core strengthening exercises, flexion biased strength based exercises, chiropractic/alignment joint mobilization procedures to facilitate biomechanics and spinal function. Natural anti-inflammatory support such as proteolytic enzymes, boswellia, turmeric, bioflavonoids and arctic omega 3 fish fatty acids should be consumed for 60 days to down regulate the inflammatory cascade of the injury. Bone and collagen based nutrition should be implemented (Ligaplex I and II (Standard Process), Collagenics (Metagenics), and Ossopan MD (MCHC) (Xymogen) for 6 months to one year to help nourish the stabilization effect on the lower back structures.
For Grades 4 or 5 may require surgical intervention to stabilize the damaged vertebra to prevent further potential nerve damage.
Prevention of Spondylolisthesis:
This condition cannot be completely prevented due to athletic activities like gymnastics, weight training, football and other contact sports. However, proper technique and dedicated training to strengthen the core and spinal muscles will re-enforce the entire lumbar spinal system making it more protected against repetitive stressors that occur in sports and athletics.