Spondylolisthesis

In spondylolisthesis, one bone in your back (vertebra) slides forward over the bone below it. This condition most frequently occurs in the lower spine (lumbosacral area). In some cases, it may lead to compression of your spinal cord or nerve roots, which can cause back pain and numbness or weakness in one or both legs. In rare instances, it can also result in loss of control over your bladder or bowels. Contact a doctor immediately if you begin to lose bladder or bowel control.

Sometimes, when a vertebra slips out of place, you may have no symptoms at all or only experience symptoms years later. Later on, you might notice pain in your lower back or buttock. Muscles in your leg may feel tight or weak, and you might even develop a limp.

Problems with the small joints in your back, known as spondylolysis, may cause spondylolisthesis. Possible issues that can lead to spondylolisthesis include a defective joint that you’ve had since birth (congenital), a joint damaged by an accident or other trauma, a vertebra with a stress fracture caused by overuse of the joint or a joint damaged by an infection or arthritis.

Spondylolisthesis affects children and teens who participate in sports. Certain sports, such as gymnastics and weightlifting, can excessively strain the spinal bones, leading to stress fractures in the vertebrae, which may result in this condition.

Older adults can also develop spondylolisthesis due to wear and tear on the spine, which can lead to stress fractures. Spondylolisthesis can also occur without stress fractures when the discs and joints deteriorate and slip out of alignment.

The most common risk factors for spondylolisthesis are age, genetics, certain sports, carrying extra weight, spinal conditions (osteoporosis, spondylolysis, deformities or arthritis) and previous spinal trauma or other medical conditions like Paget’s disease of bone or spinal infections. Maintaining healthy posture and weight can significantly reduce the risk of spondylolisthesis.

Preventing spondylolisthesis starts with maintaining a healthy weight, practicing good posture and engaging in regular physical activity that includes core-strengthening and flexibility exercises. Strengthening the bones by taking calcium and vitamin D supplements can also be beneficial.

Symptoms of spondylolisthesis may include:

• Back or buttock pain
• Pain radiating from the lower back down one or both legs
• Numbness or weakness in one or both legs
• Difficulty walking
• Leg, back or buttock pain that intensifies when bending over or twisting
• In rare cases, a loss of bladder or bowel control

Sometimes, spondylolisthesis causes no symptoms at all.

To check for spondylolisthesis, your doctor will inquire about your symptoms and perform a thorough examination. You will receive a diagnosis through a physical exam and imaging tests, such as X-rays, computed tomography (CT) scans or magnetic resonance imaging (MRI). Your doctor will assess pain levels, range of motion and physical signs to accurately diagnose the condition.

Treatment for spondylolisthesis starts with stopping any physical activities that may have harmed the vertebrae or worsened the pain. To relieve discomfort, your doctor might suggest nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) or naproxen (Aleve). Alternatively, acetaminophen (Tylenol) can be used for pain management.

Doctors typically recommend physical therapy to strengthen the core muscles, including the abdominal and back muscles. Losing weight can also be beneficial. Surgery might be considered if the pain is severe, the vertebrae continue to shift or if there is damage to the nerve root or spinal cord due to the condition. This procedure relieves pressure on the spinal cord or nerves (decompression). Additionally, the bones may be fused in place. Sometimes, both decompression and fusion are performed in the same surgery.

After any of these surgical procedures, you may need to wear a cast or back brace. Following that, rehabilitation therapy will help strengthen your muscles and enhance your mobility.

Symptoms of spondylolisthesis typically improve with physical therapy, over-the-counter pain medication and rest. If the condition is exacerbated by overuse, a lifestyle change may be needed to prevent flare-ups. Many patients also experience relief by incorporating regular, gentle exercise and maintaining a healthy, anti-inflammatory diet.