Spondylolisthesis: Diagnosis and Treatment

"You're between a I and a II," the orthopedic surgeon explained, glancing toward one of my X-rays. He had just told me the sporadic shooting pain in my lower back that sometimes compromised my ability to move was due to a disorder known as spondylolisthesis. After discussing the diagnosis, he suggested starting with conservative treatment options.

Overview

Spondylolisthesis occurs when a vertebra manages to slip out of position and onto the one immediately below it, according to the Cleveland Clinic. Once the slippage reaches a certain point, the vertebra often presses on a nerve, resulting in pain generated most often in the lower back.

Experts classify the types of spondylolisthesis according to their cause. The most prevalent types are the result of spinal degeneration, congenital problems, trauma or injuries, various diseases and post-operative surgical problems. Among adults, the most frequent cause of the disorder is degenerative diseases such as arthritis, MedlinePlus reports.

Certain physical activities like lifting weights and playing football put participants at risk for shifting vertebrae and stress fractures. Individuals with a family history of back problems or being overweight also face an elevated risk, according to MedicineNet.

The most common sign of spondylolisthesis is lower-back pain. Many patients also report pain that radiates down a leg to the foot, along with tingling and/or numbness. Complications include the loss of bladder function or bowel control.

Diagnosis

Since back pain is so common, especially among patients who are older than 40, it's usually impossible to diagnose spondylolisthesis based solely on a history and physical exam. Doctors usually begin by ordering X-rays. Side views will reveal slippage of vertebrae. For some patients, CT or MRI scans are required to more clearly visualize the bones and nerves in the region of the slippage.

Based on the percentage of slippage visible, each case receives a grading:

Grade I: Up to 25 percent

Grade II: Between 26 and 50 percent

Grade III: Between 51 and 75 percent

Grade IV: Between 76 and 100 percent

Grade V: Technically known as spondyloptosis, it happens when one vertebra has completely fallen off the next one.

Treatment

The Cleveland Clinic reports that Grade I and II slips usually require only medical treatment. For III and IV, however, surgery might be recommended if the patient experiences persistent pain.

Doctors prescribe three general types of treatment for spondylolisthesis. Standard medical practice is to begin with the most moderate treatment possible, based on each patient's circumstances.

Conservative treatment includes resting the back and avoiding sports or other physical activities most likely contributing to the disorder. Some physicians recommend reducing pain and inflammation by taking over-the-counter (OTC) non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (brand name: Motrin) or naproxen (brands names: Aleve and Naprosyn). However, they sometimes find it necessary to prescribe stronger medications or administer epidural steroid injections. Devices like braces and back supports are also effective in relieving some patients' symptoms.

Exercise might take the form of walking, an at-home program or physical therapy for up to 12 weeks. Periodic assessments during this period determine if there is any additional slippage.

Surgery is the recommendation when other methods of treatment have failed to control the individual's pain and ability to move. Two types are the most common for spondylolisthesis. A decompressive laminectomy removes the section of bone identified as pressing on the patient's nerves. Doctors perform spinal fusion by transplanting a piece of bone to provide spinal stability.

Fortunately, the majority of patients with spondylolisthesis respond to conservative methods of treatment. The prognosis for most of them is good. When all indications point to surgery, the appropriate procedure can accomplish a great deal toward eliminating pain and restoring the individual's ability to function.

Sources:

http://my.clevelandclinic.org/disorders/Back_Pain/hic_Spondylolisthesis.aspx

http://www.nlm.nih.gov/medlineplus/ency/article/001260.htm

http://www.medicinenet.com/spondylolisthesis/article.htm