Spondylolisthesis Treatment

We treat Spondylolisthesis Grade 1 and Grade 2 in Adults and Children. This technical article describes the types spondylolisthesis, who gets spondylolisthesis, common symptoms, exercise and stretch recommendation and treatment options.

Spondylolisthesis or slipped disc is a medical term that refers to a slippage of one vertebral body over another. This most commonly involves the fourth and fifth lumbar or the fifth lumbar and first sacral vertebral bodies. There are a number of reasons for the slip, one of, which is called spondylolysis. This not the same as spondylosis a degeneration condition most commonly seen neck and back condition on xray. Spondylolysis is another name for isthmic spondylolisthesis. In these cases, there is a defect in a portion of the spine called the “pars interarticularis”, on x-rays, it is seen as the neck of the “Scotty dog” as described by radiologist.

Spondylolisthesis is the most common cause of back pain in adolescents but most cases are asymptomatic. Symptoms when they occur often begin with the growth spurt. When symptoms occur, the course can be slow, progressive and severe. Long asymptomatic periods are common. We will discuss this in spondylolisthesis in children article.

5 Grades or Degree of Slippage in Spondylolisthesis

Grade I = 1-25% slippage
Grade II = 25-50% slippage
Grade III = 50-75 % slippage
Grade IV = 75-100 % slippage
Grade V = complete slippage of vertebral body

The most common symptom of spondylolisthesis is achy type of pain. The exceptions are the degenerative, traumatic and pathologic types of spondylolisthesis. There are 2 types of pain seen in cases of spondylolisthesis. One is a sciatic type of pain with radiation (spread) to the buttock, back of the thigh and calf. This is due to stenosis of the lateral recess (the area of the spine where the nerve exits). This type of pain may be mistaken for a lumbar disc herniation.

The second pain presentation in spondylolisthesis is claudication type pain. While claudication means limping, the pain is generally related to activity, walking or prolonged standing. The pain in these cases is located in the back, buttocks, thighs or calves. It improves with rest, either sitting or lying down.

Spondylolisthesis occurs 5-7% in Caucasians, 7–10% have been recorded for Asian and Asian-derived population according to International Journal of Osteoarchaeology (May2005) and 40% in the Eskimo population. Unfortunately, young children including toddlers can get Spondylolisthesis shortly after beginning to walk as a result of repeated falls especially if premature walking occurs. The Ischemic type occurs in 5-6 year olds, and the degenerative type Spondylolisthesis occurs in the elderly. If your occupation or sports that require repetitive extension/flexion movements, gymnastics, diving, football, weight lifters, pregnancy, you stand a higher chance of getting spondylolisthesis.

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There are 5 types of Spondylolisthesis or slipped disc. The pathologic cause is the one we wish we never see in our patients. One of the main reasons to take xray is to rule out the possibility of bone tumor or disease.

Dysplastic or Congenital Spondylolisthesis is the inadequate development of the posterior elements without slippage is spondylolysis. More common in women and usually occurs during their growth spurt in 14-21% of cases.

Isthmic type of Spondylolisthesis is caused by a break of the pars interarticularis as a result of a fatigue fracture (most common), acute trauma (rare) or repeated micro trauma leading to elongation. More common in men and in about half of the cases there is no slippage in 5-20% of cases seen. I had a friend who had Spondylolisthesis of the isthmic type and hgis main symptom is chronic back ache that comes and goes.

Degenerative Spondylolisthesis on the other hand is a break in the pars interarticularis as a result of erosive pressure from the superior articular facet below and the inferior articular facet above. More common in women and occurs after 40 years of age. Degenerative spondylolisthesis is usually a result of long standing instability most common at the junction of the 4th and 5th lumbar. The instability is a result of disc degeneration and facet joint degeneration.

Traumatic Spondylolisthesis is a break in the neural arch as a result of acute trauma to any area other than the pars interarticularis.

Pathologic Spondylolisthesis is the 5th type resulting from a destructive lesion to the pars interarticularis as a result of dysplasia, carcinoma, metastasis, severe osteoporosis, Paget’s disease or others. This is the least common cause.

We recommend in include knee to chest stretches of tight iliopsoas and hamstring may temporarily relief some symptoms. Core strengthening exercises include pelvic tilt and especially lower abdomen is helpful. I do not recommend patient trying out their own exercise or stretching as some exercise such as a Yoga Cobra will make a spondylolisthesis worst or if you have a spondylysis, it can initiate a spondylolisthesis. I have some patients after a Pilates or Yoga session complaining of more pain.

The treatment of spondylolisthesis can be complex and depends on the signs and symptoms. At Lifesystems Chiropractic we use a system of treatment that do not require long treatment plans to see significant results. Feel free to email me or call for an appointment if you suspect a spondylolysis or spondylolisthesis.

If you have a Grade 3 or more Spondylolisthesis and conservative care such as chiropractic treatment or physiotherapy did not relieve symptoms, surgical consult may be warranted. Surgical treatment is divided into two possible approaches, decompression and decompression with fusion. Decompression without fusion is generally avoided as it may lead to further slip and progressive problems. Most surgical procedures include both decompression and fusion. Fusion may be done in situations where no attempt is made to reduce (correct) the slip. In some cases, an attempt may be made to reduce the slip to create a more “normal” appearance to the spine. 

Frequently, some type of fusion instrumentation will be implanted along with bone graft. The surgeon will decide on the specific type of surgery after taking into account the patients symptoms and the appearance of the various imaging studies. The good news unless you had a severe accident, most have a Grade 1 or 2 spondylolisthesis with is very treatable without surgery. Call us today for a consult.