Spondylolisthesis in Adults
Spondylolisthesis describes a condition of forward slippage of
one vertebrae
in the spine over another. This condition in adults is most commonly
due to degeneration (wear and tear) of the discs
and ligaments that bind and support the spine. In some patients
spondylolisthesis may have developed in childhood. This is a very
different group of patients and no treatment at all may be necessary.
In the true degenerative adult spondylolisthesis one most commonly
notes a forward slippage of the L4 vertebra
over L5 vertebra
(lowest part of the spine). Although back pain is the most common
symptom of this condition, when nerve
compression occurs then numbness in the legs, heaviness, tingling
and weakness may also develop, particularly with walking, prolonged
standing and other activities. (See Spinal Stenosis)
Imaging tests, such as MRI and CT scans are very helpful in demonstrating
the degree of spine slippage in spondylolisthesis and any areas
of stenosis, or a 'pinched
nerve' in a narrow spinal
canal. One must realize that these tests are obtained when
the patient is lying down (supine) on an imaging table. However,
most of the symptoms are aggravated by standing, walking and other
activities and the tests do not always correlate well with the
symptoms. In other words, some people have spinal
canals that appear very narrowed and yet they have no significant
symptoms, while others suffer greatly despite tests that do not
reveal such marked narrowing of the spinal
canal.
Treatment options
Non-operative treatment can be successful in mild cases of spondylolisthesis
by using braces and pursuing back strengthening exercises. When
non-surgical treatment fails then an operative procedure may be
considered. Various surgical approaches have been developed to
treat adult spondylolisthesis the treatment for spondylolisthesis
must aim at not only freeing up a narrowed spinal
canal (commonly called a decompression) but more importantly
at stabilizing the spine in an optimal position. If the spine
is found to be very unstable (excessive motion at the level of
slip) then a fusion is commonly performed. In the setting of a
stable spine it is frequently sufficient to decompress the levels
of stenosis. With proper surgical technique in carefully selected
patients very good results can be obtained. (Read more in the Surgical Procedures Section)
Frequently
Asked Questions
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