Spondylolisthesis

The most frequent abnormalities are: Lumbosacral transitional anomalies Scoliosis Hyperyphosis Hyperlordosis Rectification Spondylolysis Spondylolisthesis Vertebral arthritis Facet arthritis Spinal stenosis Fissure, protrusion and disc herniation Postoperative fibrosis Dislocation of the coccyx Atlantoaxial Dislocation Sprain Whiplash Syndrome

What it is

It consists of the displacement of one vertebra over another. There are two types, depending on whether the displacement is forward ("anterolisthesis") or backward ("retrolisthesis"). They are classified in four grades according to the extent of displacement.

How it takes place

This is most commonly a complication of spondylolysis, occurring when the two parts of the vertebral lamina separate.

In other cases there is deformation of the facet joint in a specific segment (normally the fourth or fifth lumbar vertebra) so that it is a different size from the other segments and the vertebra is out of alignment with the others.

In yet other cases, it is caused by an accident or major traumatism, causing the vertebra to shift position, with or without fracture.

Sometimes the degree of slippage progresses over the years.

Symptoms

Spondylolistheses I and II normally cause pain. They turn up by chance in X-rays and it has been demonstrated that it is a mistake to operate if they cause no problems.

Although not always, spondylolistheses III and IV can cause low back pain. If they produce compression of the nerve, they can cause major or progressive loss of strength, or pain irradiating to the legs.

Risk

Spondylolistheses III and IV can produce nerve compression.

Compression can also appear following surgery where upon operating it is decided to reposition the vertebrae -that is- not only to fix them but also to realign them. For that reason, today when there is no choice but to operate, the tendency is to be as unaggressive as possible.

Diagnosis

To diagnose and quantify the degree of spondylolisthesis, X-rays are required.

If the onset of compression of the nerve is suspected, it may be worthwhile doing neurophysiological tests.

Treatment

Grade I and II spondylolistheses are usually free of pain and surgery has proven useless when there are no other associated problems. Physical exercise should be prescribed to prevent progression. Exercises should be adapted for each patient, depending on the exact spinal site, type and grade of spondylolisthesis.

Most cases of spondylolistheses that cause pain respond to conservative treatment and there is no need to operate.

Surgery is only necessary in grade III and IV spondylolistheses when vertebral displacement produces nerve compression, causing important or progressive loss of strength, or radiated leg pain. Where indicated, the normal procedure is arthrodesis.

Some of the existing recommendations based on scientific evidence establish that, except in those cases where major accident or trauma has produced vertebral fracture or displacement (what by definition is not considered common back pain), surgery should not be the choice in the first 3 symptomatic months.