Instability (Spondylolisthesis)

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In spondylolisthesis, one of the bones in your spine - called a vertebra - slips forward and out of place. This may occur anywhere along the spine, but is most common in the lower back (lumbar spine). In some people, this causes no symptoms at all. Others may have back and leg pain that ranges from mild to severe.

What causes spine Instability (Spondylolisthesis)
There are several causes/types of spondylolisthesis. The two most common types in adults are degenerative and spondylotic/congenital.

Degenerative - General wear and tear causes changes in the spine. As we age, the intervertebral disks in the spine lose height, become stiff, and begin to dry out, weaken, and bulge. As these disks lose height, the ligaments and joints that hold our vertebrae in proper position begin to weaken. In some people, this can create instability and ultimately result in degenerative spondylolisthesis.

As the spine continues to degenerate, the ligaments along the back of the spine may begin to buckle, resulting in nerve compression. As the slippage in the spine worsens, the spinal canal can also become narrowed. Ultimately, this narrowing and buckling lead to compression of the spinal cord (spinal stenosis). Spinal stenosis is a common problem in patients with degenerative spondylolisthesis.

Patients with degenerative spondylolisthesis will often develop leg and/or lower back pain when slippage of the vertebrae begins to put pressure on the spinal nerves. The most common symptoms in the legs include a feeling of diffuse weakness associated with prolonged standing or walking.

Surgery for degenerative spondylolisthesis will relieve the nerve compression and prevent instability. In most cases, relieving the nerve compression is more important. This is typically achieved with laminectomy — a procedure during which your doctor removes the bone spurs and thickened ligaments causing the compression. Sometimes, your surgeon may be able to indirectly decompress your spine using other surgical methods.

If your doctor believes your spine is stable enough, you may not need to have it stabilized with a spinal fusion.

Isthmic spondylolisthesis - A crack (stress fracture) in the vertebra. The fracture typically occurs in an area of the lower (lumbar) spine called the pars interarticularis.

Most patients with isthmic spondylolisthesis have low back pain, which they believe is activity-related. The back pain is sometimes accompanied by leg pain. In elderly patients, isthmic spondylolisthesis can also be accompanied by symptoms of spinal stenosis.

If you have isthmic spondylolisthesis and your symptoms have not improved after 6 to 12 months of nonsurgical treatment, you may be a candidate for surgery. Other indications for surgery include progressive neurologic symptoms, such as weakness, numbness, or falling, and/or symptoms of damage to the nerves below the end of the spinal cord (cauda equina syndrome).

Stabilization of the spine is the main goal of surgery for isthmic spodylolisthesis. This is achieved by spinal fusion, a welding process that typically uses screws and rods to fuse together two or more vertebrae into a single, solid bone. If you also have nerve compression, your doctor may elect to decompress the spine through a laminectomy.

Columbia Orthopaedic Group spine specialists use the same tools to diagnose both degenerative spondylolisthesis and isthmic spondylolisthesis and my include the following to confirm and make a diagnosis:

  • Medical History and Physical Examination
  • Imaging tests (X-ray, MRI, CT)

Non-surgical treatment options
Although nonsurgical treatments will not repair the vertebral slippage, many patients report that these methods help relieve symptoms.

  • Physical therapy and exercise. Specific exercises can strengthen and stretch your lower back and abdominal muscles.
  • Medication. Analgesics and non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen, may relieve pain.
  • Steroid injections. Cortisone is a powerful anti-inflammatory. Cortisone injected around the nerves or in the outermost part of the spinal canal (epidural space) can decrease swelling, as well as pain. Cortisone injections are likely to decrease pain and numbness, but not weakness of the legs. Patients should not receive cortisone injections more than three times per year.

​​What's Next? Treatment Options...

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Columbia, Missouri 65201

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