As we age, our body degenerates with time. However, some people have a higher risk of certain degenerative conditions due to a genetic bias. While some will have high cholesterol, others may suffer with spinal degenerative disc disease or spinal stenosis. One condition in particular, common within the aging population, is called spondylolisthesis. Spondylolisthesis is derived from the Greek words “spondy”, meaning vertebra, and “listhesis”, meaning movement. Spondylolisthesis is an abnormal condition in which there is instability in the spinal column, as one vertebral body is shifting forward over the next vertebrae.
Lumbar Spondylolisthesis produces distinct symptoms differing from other spinal conditions. The most common complaint is pain when standing and bending over a countertop or sink. Prolonged standing is also difficult. The instability can also compress nerves in the spinal canal causing nerve pain into the buttocks and down the legs all the way to the feet. Numbness and weakness can be present to varying degrees as well.
The most common level at which this occurs is between the 4th and 5th lumbar vertebra in the lower back. This condition is diagnosed radiographically with lumbar spine x-rays taken with the lumbar spine in the flexed and extended positions.
A Lumbar spine MRI can be performed showing more details of the spinal column and the degree of compression on the nerves at the level of Spondylolisthesis. Spinal stenosis is narrowing of the spinal canal or exit sites that can compress nerves causing back and leg pain. Stenosis is typically caused by degenerative overgrowth of ligaments and joints that compress the nerves.
Treatment options usually begin with trying oral anti-inflammatories, such as ibuprofen or Naprosyn. Physical therapy (PT) is usually prescribed as well. PT will help strengthen the spinal musculature and decrease the symptoms. If symptoms persist or are severe, having interventional pain management can be an option. This is done through injections in the spinal canal or joints to reduce the inflammation and alleviate the pain. However, if the injections are not providing several months of relief, no further injections are recommended.
As many patients may have Spondylolisthesis but may not have severe symptoms, not all patients need surgery. The discussion with the surgeon should highlight why surgery is indicated and what are that surgeon’s typical outcomes based on his or her techniques.
Surgical treatment is a last option if non-operative treatment has failed. Surgery typically involves a decompression with or without fusion. The decompression is done via removing bone and disc to open the space for the nerves within the spinal canal. Fusion is necessary to stabilize the unstable spondylolisthesis. The fusion is performed via inserting spinal instrumentation, screws and cages, to stabilize the vertebral bodies. Bone graft, either cadaver bone or the patient’s own bone, is also inserted to grow bone between the two vertebral bodies to heal, or fuse, them together. Synthetic options are also available if patients do not wish to have cadaver bone used in their operation. Patients should discuss bone graft and spinal instrumentation options with their surgeon as different techniques, both minimally invasive and open surgical options are available, but have differing risks and benefits.
Risks of surgery vary based on the surgical technique but the most common risks involve bleeding, infection, nerve injury, dural tears, pseudoarthrosis (failed fusion), loosening of hardware, and adjacent level joint and disc degeneration. Even with these risks present, the benefits of surgery often outweigh these risks, but a thorough discussion with the surgeon will help keep these in perspective.
Recovery varies based on patient age, medical conditions and surgical approach. Most patients are usually in the hospital 1-3 days in the hospital. Typically, they are usually up and walking the day after surgery with or without a walker.
Return to activities is typically based on healing and surgeon’s recommendations. Walking is recommended right after surgery but gardening, running or gym exercises are not recommended until usually after 3 months, sometimes even up to 6 months. This time frame is discussed with the surgeon as each may have varying times to return to sports and other activities.
Epidural Steroid Injections