Spondylolisthesis

Spondylolisthesis (‘spondyl’ = spinal + ‘olysthesis’ = with slippage) is the forward slippage of one vertebra on the vertebrae below. The most common involved is L5 (the 5th lumbar vertebra) slipping forward on S1 (1st sacral verteb …

Spondylolisthesis (‘spondyl’ = spinal + ‘olysthesis’ = with slippage) is the forward slippage of one vertebra on the vertebrae below. The most common involved is L5 (the 5th lumbar vertebra) slipping forward on S1 (1st sacral vertebra. There are varying degrees of slippage, graded by the distance the slipping vertebra moves forward on the body of the vertebra below.

This occurrence often results in no noticeable symptoms, and probably 80% of people never even know they have the problem.

Approximately 5-6% of males, and 2-3% of females have a spondylolisthesis. It becomes apparent more often in people who are involved with very physical activities; in particular sports that require repetitive hyperextension.

Although some children under 5 years may be pre-disposed towards having a spondylolisthesis, it is rare that such young children are diagnosed with spondylolisthesis. Spondylolisthesis becomes more common among 7-10 year olds. The increased physical activities of adolescence and adulthood, together with the wear-and-tear of daily life, result in spondylolisthesis being present among both adolescents and adults.

Types of spondylolisthesis include:

Congenital Spondylolisthesis is caused by an irregularity of the spinal bones. A person may be born with an abnormality of the posterior bones of the spine. Because of this irregularity, the normal ability of the spine to resist slippage is lost. The most common symptom is back pain that usually begins with the growth spurt of adolescence. It is more commonly seen in females.

Isthmic Spondylolisthesis is a small stress fracture in the posterior arch of the slipped vertebra. This fracture disconnects the vertebral body from the small joints (facet joints) that help to control vertebral motion. In this situation abnormal stresses are placed on the intervertebral disc at that level, which may result in forward slippage of the vertebra. Scar tissue often forms over the fracture as the body tries to heal itself. When this occurs, it may cause compression on the spinal nerves resulting in leg pain, or tingling and numbness in the leg.

Patients with isthmic spondylolisthesis typically present during their teenage years.

Degenerative Spondylolisthesis is characterised by degenerative changes in the stabilising structures of the lumbar vertebrae, which result in a forward slippage of a portion of one lumbar vertebra. The slippage occurs when the disc in front of the spine ages, loses water and some of its ability to resist motion. In response, the joints in the back of the spine increase in size and develop extra soft tissue and bone (spurs) to compensate. This extra tissue and bone impinges on the nerve roots and can weaken the joints in the back of the spine causing slippage.

This condition tends to affect women over the age of 40yrs. and diabetics with greater frequency. The ‘slip’ generally occurs most often in the lower back, specifically between the 4th and 5th lumbar vertebrae (L4-L5). Although aging adults can expect some degenerative processes to occur in their spines, this certainly does not point to a future facing disability. In general, spondylolisthesis only affects a small percentage of the population. Overall, most degenerative disorders of the spinal can be treated non-surgically with good outcomes.

Traumatic Spondylolisthesis is a rare condition usually brought about by major trauma, resulting in fractures of the pars interarticulares ( part of the spine’s facet joint.)

Pathological Spondylolisthesis may be the result of destruction of the posterior aspect of the spine through either a tumor or infection of the bone, or severe osteoporosis. The disruption of the bone allows the slippage. This is one of the less common causes of spondylolisthesis.