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Submitted by: Patrick Foote
Hearing spondylolisthesis causes some individuals to wonder whether the speaker is using a foreign language. While it may have originally derived from the Greek words for vertebrae and dislocation, the word spondylolisthesis is, in fact, part of the English language. Understanding how to pronounce or spell spondylolisthesis is one thing, but comprehending what it is and how it is caused is another matter altogether. So what exactly is this odd-sounding condition and what causes it, anyway?
Though its name makes the condition seem highly complex and difficult to comprehend, spondylolisthesis is actually quite simple to understand one you know a little bit about the spinal anatomy. The main components of the spine include:
Spinal cord The so-called information superhighway, the spinal cord is a large bundle of nerves that delivers sensory and motor signals from the brain to the rest of the body.
Spinal nerves These tiny branches stem from the spinal cord and travel throughout the body, providing feeling and mobilization for every part of our bodies, from our heads to our toes.
Vertebrae Bone structures that house and protect the spinal cord. Most people have a total of 33 vertebrae; nine are fused together to form the coccyx and the sacrum while the 24 individual vertebrae in the neck and back are articulated with each other.
Facet joints These synovial joints are tasked with connecting articulating, adjacent vertebrae.
Intervertebral discs Positioned between articulating vertebrae, these saucer-shaped pads absorb the impact that is placed on the neck and back when the spine facilitates movement and supports weight.
Now that youre aware of the various components of the spine and the tasks they perform, its time to explain what spondylolisthesis is and how it develops. Simply stated, spondylolisthesis is vertebral displacement that occurs when one vertebra shifts forward and over the vertebra beneath it.
When spondylolisthesis is diagnosed, the physician assigns a grade to the condition that identifies the extent to which the affected vertebra has shifted out of place:
Grade 1 0 to 25 percent slippage
Grade 2 25 to 50 percent slippage
Grade 3 50 to 75 percent slippage
Grade 4 75 to 100 percent slippage
Grade 5 the vertebra is completely displaced and is no longer positioned above the vertebra directly below it
What Does Spondylolisthesis Feel Like?
Interestingly, spondylolisthesis causes no symptoms in many patients. This has to do with the fact that neural compression is what often causes symptoms, not the actual displacement of a vertebra. Especially in cases of low-grade spondylolisthesis, the spinal nerves and the spinal cord are unaffected and, therefore, the patient remains unaware that they are even afflicted with the condition. Higher grades, however, can and typically do lead to pinched nerves or even compression of the spinal cord itself. This causes patients to experience radiating symptoms of pain, numbness, tingling, and muscle weakness. When spondylolisthesis occurs in the lower back (the portion of the spine most susceptible to vertebral displacement), patients may have difficulty walking and may appear to have a protruding abdomen.
What Causes Spondylolisthesis?
Believe it or not, the primary cause of spondylolisthesis and other degenerative spine conditions is simply the natural aging process. After supporting the weight of the upper body and facilitating every bend, twist, lift, and so forth, its no wonder that the neck and back tend to become sore and tired by about middle age. In fact, almost every portion of the spine is prone to degenerative changes, which occur slowly over time.
The facet joints are one of the primary victims of the natural aging process, as years of articulated movement can cause the cartilage that lines the joints to wear away. When the bones of the joints uncomfortably rub against one another, they can become inflamed, painful, and tender to the touch, and may be less able to perform their responsibilities, leading to loss of mobility. This is called facet disease, which is a type of arthritis and is also sometimes called facet syndrome or spinal arthritis.
The intervertebral discs also undergo several changes during the natural aging process. An intervertebral disc has a tough outer shell, called the annulus fibrosus, that can become weak and brittle with age. A discs inner material, called the nucleus pulposus, can lose water content and elasticity, preventing the disc from properly absorbing impact. Together, these changes can cause a herniated disc, which occurs when the annulus fibrosus ruptures and the nucleus pulposus seeps into the spinal canal, as well as a bulging disc, which occurs when the annulus fibrosus becomes too weak to properly support the nucleus pulposus, allowing it to shift out of place and balloon to one side.
So what do facet disease, herniated discs, and bulging discs have to do with spondylolisthesis? All of these degenerative spinal conditions lead to inadequate support of the vertebrae, which sometimes causes spondylolisthesis.
How is Spondylolisthesis Treated?
For the most part, a patients treatment regimen will depend on the extent to which the affected vertebra has slipped out of place. In the case of low-grade spondylolisthesis, most physicians advise their patients to initially utilize a conservative, nonsurgical treatment plan that is aimed at easing symptoms rather than on reversing vertebral slippage. This almost always entails the use of medication, primarily over-the-counter, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. Certain medical conditions, especially those that affect the gastrointestinal or cardiovascular system, prohibit patients from taking NSAIDs. Instead, these patients may be advised to take over-the-counter analgesics such as acetaminophen. If a patient is experiencing severe or debilitating pain, his or her physician may prescribe narcotic pain relievers or muscle relaxants.
In addition to medication, the patients treatment regimen may include one or more of the following:
Lifestyle modifications (i.e. weight loss)
Transcutaneous electrical nerve stimulation (TENS)
Some patients with low-grade spondylolisthesis may receive little to no relief from nonsurgical treatments after several weeks or months. A minimally invasive procedure that serves to decompress an affected spinal nerve may provide relief, which can typically be achieved after a week or two of rehabilitation. These procedures are performed on an outpatient basis and utilize an endoscope to gain access to the spine through a very small incision.
High-grade spondylolisthesis causes more severe symptoms that cannot always be alleviated through the use of conservative techniques. Some of these patients may be advised to undergo spinal fusion surgery, which entails the installation of a bone graft and stabilizing hardware to reverse vertebral slippage and prevent it from reoccurring.
Now that youve become familiar with the spinal anatomy and how it is affected by spondylolisthesis, you likely have a better understanding of what the condition is and why it occurs. Hopefully youve also realized that, while spondylolisthesis causes pain and discomfort, it doesnt have to cause confusion no matter how complex its name makes it seem. If you have been diagnosed with spondylolisthesis, talk to your doctor about the various treatment options that are available to you.
About the Author: Patrick Foote is the Director of eBusiness at Laser Spine Institute, the leader in endoscopic spine surgery. Laser Spine Institute specializes in safe and effective outpatient procedures for the treatment of
and several other spinal conditions.