Spondylolisthesis Treatment in Delhi, India

Spondylolisthesis is a disorder of the spine characterised by slipping one of the spinal vertebrae from its original position onto the one below it. This leads to inflammation and pain at the affected site.

Spondylolisthesis is more common in the lumbar region, causing lower back pain. Spondylolisthesis can be congenital, isthmic (due to fractures), or degenerative (age-related).

Associated Anatomy of Spondylolisthesis

Spinal bones

Alternate Name of Spondylolisthesis

Olisthesis

Spondylolisthesis Causes

Causes of spondylolisthesis include the following:

Sports

Injury or overexertion of the spine in young athletes during sports or athletics is the most common cause of spondylolisthesis. Overexertion leads to displacement of the vertebrae causing pain and inflammation.

Genetics

Another cause of spondylolisthesis is thinner vertebras due to genetic disorders, which tend to get broken easily.

Age

Weakened bones and degenerative changes with ageing can lead to spondylolisthesis in people above 50.

Spondylolisthesis Symptoms

Many people might not experience any symptoms, and it might go unnoticed for years. Lower back pain is the most common symptom. Other signs and symptoms of spondylolisthesis include the following:

• Stiffness in the lower back
• Spasms in the hamstring muscles
• Numbness or weakness in the feet
• Tingling sensation in the feet
• Difficulty in walking
• Difficulty in standing for long hours
• Pain while bending.

Spondylolisthesis Diagnosis

Clinical presentation of spondylolisthesis usually involves pain symptoms that could mimic various conditions such as inflammatory arthritis, lumbar fibromyositis, lower back strains, lower back sprains, lumbar bursitis, lumbar radiculopathy, and other disorders of the spinal cord, nerves, and plexus. Hence, a differential diagnosis is required to rule out other inflammatory conditions.

Spondylolisthesis Test

Typical diagnosis includes a physical examination and assessing your symptoms by the doctor. Your doctor will advise you to undergo a spinal X-ray to assess the cause of the pain and see if the vertebras has moved beyond the normal movement. In addition, the doctor might ask for additional imaging tests such as a CT scan or Magnetic resonance imaging (MRI) to confirm the diagnosis and examine the soft tissues for any deformities.

Stages of Spondylolisthesis

Spondylolisthesis can be categorised into the following stages depending upon the degree of the vertebrae slippage:

• Grade I: Slippage is between 0 to 25%.
• Grade II: Slippage is between 26 to 50%.
• Grade III: Slippage is between 51 to 75%.
• Grade IV: Slippage is between 76 to 100%.
• Grade V: Slippage is more than 100%.

Spondylolisthesis Treatment

Treatment options for spondylolisthesis include the following:

Medications & Rest

Taking rest and avoiding strenuous activities or sports until the pain has subsided.

Medications include painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs), calcium supplements, and steroidal injections in non-responding cases.

Physical therapy

Physical therapy helps to strengthen the muscles and increase flexibility and movement. Regular physiotherapy helps alleviate the pain and inflammation.

Bracing

Braces can be used in children to support the spine and limit the movement for a quick recovery.

Surgery

Surgery is preferred in severe cases and could involve decompression and/or fusion of the vertebras depending upon the affected area.

Risk Factors of Spondylolisthesis

Risk factors for spondylolisthesis include the following:

• Age: Degenerative changes in the musculoskeletal system start to develop as you age. Adults aged 50 years are more at risk of degenerative changes to develop spondylolisthesis.
• Athletes: Young athletes involved in sports such as football or gymnastics are at increased risk of developing spondylolisthesis due to excessive stretching of the lumbar spine.
• Genetics: Some people have thin sections in the vertebral bone that are more prone to degeneration and breakage, increasing the risk of spondylolisthesis in such people.

Spondylolisthesis Preventions

Primary Prevention of Spondylolisthesis

Primary prevention aims to mitigate the risk factors that could lead to Spondylolisthesis. You can take the following preventive steps:

• Exercise: You should exercise regularly to strengthen your back and abdominal muscles. Exercise also keeps the muscles flexible and less prone to strains/sprains.
• Eat a healthy diet: Eating a balanced diet with a good mix of proteins, healthy fats, and carbohydrates is essential to keep your bones and muscles strong. Adding fruits, leafy vegetables, nuts, and nutritional supplements to your diet helps to strengthen bones and soft tissues.
• Maintain a healthy weight: Aim for a healthy weight as excess weight puts undue pressure on joints, bones, and muscles.

Secondary Prevention of Spondylolisthesis

Secondary prevention aims to reduce the risk of complications and recurrences. The following measure can be taken:

• Regular follow-ups: Follow-ups should be made as per the schedule to assess the recovery, risk of recurrence, and overall quality of life.
• Symptom watch-out: Always look for symptoms of recurrence or complications and seek immediate medical attention.
• Lifestyle: Exercise regularly and eat a well-balanced diet to keep your bones and muscles strong.
• Manage weight and diabetes: Managing diabetes, obesity, and weight will help to reduce the chances of complications or recurrences.

Epidemiology of Spondylolisthesis

• Spondylolisthesis occurs in around 4-6% of the adults, predominantly in young athletes.
• Women are more prone to develop spondylolisthesis compared to men.
• Dysplastic (genetic) spondylolisthesis is more prevalent in the pediatric population.
• Isthmic spondylolisthesis occurs in 6-7% of the population before 18 years.

Expected Prognosis of Spondylolisthesis

Spondylolisthesis prognosis is good as the majority of the patients get symptom-free after receiving conservative treatment. Surgery also has good acceptance and better patient outcomes in severe cases.

Natural Progression of Spondylolisthesis

Untreated spondylolisthesis tends to cause severe pain, inflammation, and movement restriction. Degenerative or isthmic spondylolisthesis worsens with age, causing more severe symptoms.

Pathophysiology of Spondylolisthesis

Spondylolisthesis occurs when the support system for vertebra alignment is affected due to overstretching or injury of the spinal cord. Injuries cause one vertebra to go out of its place and rest on the one below it. The affected motion of the vertebras leads to inflammation and pain.

Complications of Spondylolisthesis

If left untreated, spondylolisthesis can lead to chronic pain in the lower back, legs, or hamstring muscles. Numbness and weakness in the lower limbs can become severe due to nerve damage or compression. In severe and rare cases, nerves controlling the bladder and bowel movements could get compressed, causing problems with passing urine or stools.

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