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.
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.
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.
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