Spondylolisthesis & Spinal Deformities
What is Spondylolisthesis?
Spondylolisthesis occurs when a vertebra slides forward out of alignment with the rest of the spinal column. Because vertebrae tend to slip forward instead of backward, you may also hear your doctor to refer to this condition as a slipped vertebra, forward dislocation, or anterolisthesis.
A common source of back pain in young to middle-aged adults, slipped vertebrae often occur from defects or degeneration on the back side of the spine. If these deformities affect parts of the spine that should lock the vertebrae into position, a series of abnormal events can be set into motion. Namely, these structures can fail to perform their job adequately, allowing the vertebrae to slide out of position.
Keep in mind that your backbone—aptly named the spinal column—resembles a pillar. Each vertebra stacks onto the next, curving softly from your neck all the way down to your pelvis. In addition, each vertebra contains a large central hold known as the vertebral foramen. As the vertebrae stack, these holes create a channel, termed the spinal canal, that protects your spinal cord.
When a vertebra slides out of position, therefore, several serious consequences can occur. Firstly, the slipped vertebra may compress the spinal cord, a condition called central canal stenosis. This can cause a series of neurological issues, such as leg pain or muscle weakness, to emerge.
Secondly, spinal deformities, like kyphosis or “hunchback,” can result. Because your vertebral column is connected like a gigantic pillar, one rogue vertebra can throw the entire spine out of alignment. In comparison to other spinal deformities that we’ve examined, spondylolisthesis is pretty unique in this regard. A slipped vertebra can result from a spinal deformity on the posterior spine… or it can cause global spinal deformities, like kyphosis or lordosis, to arise.
What are the Major Types of Spondylolisthesis?
We can break spondylolisthesis down into different types according to spinal region, grade of severity, or cause… But, knowing the source of the disorder provides us with the most information. The 4 main types of spondylolisthesis include:
- Dysplastic Spondylolisthesis: This occurs when a congenital deformity in the facet joints causes the back side of the spine to degenerate, weakening the points of attachment that hold each vertebrae into place. Your facet joints are points of articulation on the back side of the spine where two vertebrae meet to create movement. If a facet joint becomes fragile, then a slight twist in the wrong direction can jolt the spine out of alignment.
- Isthmic Spondylolisthesis: This disorder arises when a defect in the pars interarticularis leads to a stress fracture in the vertebra. Doctors refer to this condition as spondylolysis, which literally means “bone rupture.” Your pars interarticularis is a delicate ribbon of bone that connects your facet joints together. The weakest part of your spine, the pars often snaps during childhood when we are at our most physically active. Unfortunately, this can lead to problems in adulthood, like a slipped vertebra.
- Degenerative Spondylolisthesis: This condition often appears after years of wear and tear have taken their toll on the spine. When the facet joints are healthy, they allow for a moderate level of spinal flexibility. However, as the facet joints become weak from age or overuse, they can become too flexibleor “hypermobile.” This excess movement can lead to a slipped vertebra. Degenerative conditions like osteoarthritis or degenerative disc disease only serve to speed this process.
- Traumatic Spondylolisthesis: As the name suggests, traumatic spondylolisthesis occurs when an injury such as a spinal fracture causes the vertebrae to slip. Trauma to the facet joints, pedicles, laminae, or vertebral body can easily accomplish this.
What are the Minor Types of Spondylolisthesis?
Less common types of spondylolisthesis also include:
- Pathologic Spondylolisthesis: This refers to a form of spondylolisthesis that was caused by an underlying disease. For example, spinal tumors, osteoporosis, and osteogenesis imperfecta can all encourage this vertebral slippage.
- Iatrogenic Spondylolisthesis: This form of spondylolisthesis results from a surgical error or complication. In particular, this can occur following a decompressive procedure known as a laminectomy. If the surgeon failed to take additional measures to reinforce the spine after removing the lamina–the bony casing that houses the spinal cord–then the vertebrae can become unstable and slip.
In addition, your doctor may classify your condition as cervical, thoracic, or lumbar. However, slipped vertebrae occur most often in the weight-bearing lower back, or lumbar spine. Cervical and thoracic dislocations are not unheard of… but they are relatively rare in comparison.
How Do I Know If I Have The Symptoms of Spondylolisthesis?
Spondylolisthesis symptoms often vary according to the degree of the slip and the location of the affected vertebra. Anything above a 50% slip is likely to produce severe symptoms and require surgery. (Incidentally, anything below a 50% slip isn’t particularly fun either… But, in rare cases, a patient may be asymptomatic. This is more likely to be true if the slipped vertebra occurs in the thoracic spine.) Common symptoms of a slipped vertebra include:
- Lower Back Pain: As previously stated, the weight-bearing region of the lumbar spine is the most common location for spondylolisthesis to occur. Regardless of the cause–whether injury-related or congenital, etc.–a slipped vertebra in the lumbar spine will present with back pain.
- Leg Pain: If your slipped vertebra presses against nerves that supply sensation to your legs, then you may experience searing pain or numbness in your lower body. Furthermore, if the specific nerve that is pinched happens to be the sciatic nerve, then doctors refer to this condition as sciatica.
- Tight Hamstrings: Lumbar spondylolisthesis also tends to produce hamstring stiffness. The tightness can become so severe that you cannot complete straight leg-lifts or lose your ability to bend forward at the waist.
- Muscle Weakness: A slipped vertebra can also cause spinal stenosis, or compression of the spinal cord. Aside from nerve pain, symptoms of spinal stenosis include muscular weakness, spasms, foot drop… or even paralysis. All of these things can affect your ability to walk and even shatter your independence.
- Other Pain Symptoms: If you have cervical spondylolisthesis, then you may experience upper body symptoms instead. These often include symptoms of pain, muscle weakness, or nerve dysfunction in the neck and arms.
- Spinal Deformity: A slipped vertebra can throw the entire spine out of alignment, resulting in kyphosis (aka hunchback) or lordosis (aka swayback).
How Dr. Lowenstein Can Help
Diagnosis of spondylolisthesis usually requires the patient to undergo an x-ray or MRI. Once your doctor has pinpointed the precise cause of your pain, you will likely begin a round of conservative treatments, like pain management or physical therapy.
Not every patient will be a candidate for conservative treatments, however. If you have severe spinal stenosis, spinal instability, or fractures, then you may need to undergo surgery right away. Traumatic kyphosis, for example, occurs when the spine becomes so unstable from spondylolisthesis that the torso begins to slump forward. This condition is often dangerous, requiring immediate attention to spare the spine from further damage.
When it comes to spondylolisthesis, receiving the right treatment at the right time is key to your recovery. Dr. Jason Lowenstein, MD has earned over a decade of award-winning experience in resolving spinal deformities, like spondylolisthesis and traumatic kyphosis. You can trust Dr. Lowenstein’s superior skills and compassionate bedside manner to help you navigate your recovery process!