Spondylolysis and spondylolisthesis are conditions that affect the moveable joints of the spine that help keep the vertebrae aligned one on top of the other. Spondylolysis is actually a weakness or stress fracture in one of the bony bridges that connects the upper and lower facet joints. This fracture can happen at any level of the spine but usually occurs at the fourth (L4) or fifth (L5) lumbar vertebra. This weakness can cause the vertebrae to slip forward out of their normal position, a condition called spondylolisthesis. Treatment options include physical therapy to strengthen the muscles surrounding the area. Sometimes the patient is placed in a brace. In severe cases, surgery is also an option.
Symptoms of Spondylolisthesis
Mild cases of spondylolysis and spondylolisthesis usually cause minimal pain. In fact, the conditions are often found by accident when a person has a pre-employment exam or an X-ray of the back for an unrelated reason.
When spondylolysis and spondylolisthesis do cause pain, you may experience low back pain, stiffness, and muscle spasms. You may also have sciatica (pain radiating down one or both legs), or numbness, though this is not common. Leg pain will usually be worse when you stand or walk.
The amount of pain you have depends on how fast your vertebrae are slipping. If you have very subtle symptoms, you may only feel tightness in your hamstrings or find that you can no longer touch your toes, but not feel any nerve pain.
Self care and braces: Using correct posture and keeping your spine in alignment are the most important things you can do for your back. The lower back (lumbar curve) bears most of your weight, so proper alignment of this section can prevent further slippage and injury to your spinal nerves and discs. You may need to make adjustments to your daily standing, sitting, and sleeping habits. You may also need to learn proper ways to lift and bend. You may need to wear a back brace for a short period of time while you strengthen the abdominal and lower back muscles. The brace may decrease muscle spasm and pain as well as help immobilize your spine and help the healing process. Your doctor may refer you to an orthotist who specializes in custom-made braces.
Physical therapy: The goal of physical therapy is to help you return to full activity as soon as possible. Exercise is very helpful for pain and it can help you heal faster. Physical therapists can instruct you on proper lifting and walking techniques, and they'll work with you to strengthen your abdominal muscles and lower back. They'll also encourage you to increase the flexibility of your spine and legs.
Medications: Your doctor may prescribe pain relievers, nonsteroidal anti-inflammatory medications (NSAIDs), and steroids. Sometimes muscle relaxers are prescribed for muscle spasms.
Surgical Treatments of Spondylolisthesis
If slippage continues or if your pain doesn’t respond to conservative treatment, surgery may be necessary. Surgery can address both the instability of the spine and compression of the nerve roots. The surgeon may first perform a lumbar laminectomy to relieve pressure on the nerve root. Then a bone graft will be used to fuse the loose vertebrae and keep them from sliding out of place. In some cases metal plates, hooks, rods and screws may be used to support the fusion. It may take a while for the two pieces of bone to grow together, so you should avoid extremes of motion while healing.
Fusion is successful in over 90% of cases because it stops the instable motion and keeps your spinal canal from narrowing further.