Spondylolisthesis

Spondylolisthesis occurs when one vertebra slips forward over the one beneath it, causing misalignment in the spine.
This condition can lead to back pain, leg pain, nerve irritation, and instability, especially if the slipped vertebra compresses nearby nerves.

Spondylolisthesis most often affects the lower back (lumbar spine), though it can occur in other parts of the spine as well.
The severity ranges from mild, stable cases to more advanced slips that require surgical stabilization.

Spondylolisthesis has several potential causes, depending on age, activity level, and underlying spinal health:

• Degenerative changes:
   
  • Age-related wear-and-tear weakens the joints and discs, making it easier for one vertebra to slip forward.
     
  • Most common type in adults (degenerative spondylolisthesis).
     
• Congenital or developmental defects:
   
  • Some people are born with spinal abnormalities that predispose them to vertebral slippage.
     
• Stress fractures (spondylolysis):
   
  • Repeated stress, especially in athletes like gymnasts or football linemen, can cause small fractures in the vertebra that lead to instability.
     
• Trauma or injury:
   
  • Sudden force, such as a fall or accident, may cause a vertebra to shift.
     
• Post-surgical instability:
   
  • Rarely, spinal surgery may alter mechanics and lead to slippage.Chronic wear-and-tear combined with age-related bone thinning increases fracture risk.
     

The symptoms of spondylolisthesis depend on the degree of slippage and whether nearby nerves are involved.

• Lower back pain that may worsen with standing, walking, or activity.
   
• Leg pain, numbness, or tingling (similar to sciatica) when nerves are compressed.
   
• Tight hamstrings or difficulty bending forward.
   
• Muscle weakness in the legs or feet, affecting walking or balance.
   
• Postural changes, such as a forward-leaning stance or exaggerated lower back curve.
   
• Reduced walking endurance due to pain or nerve irritation.
   
• Severe or urgent symptoms: sudden bladder or bowel control loss or rapidly worsening weakness — medical emergency.
   

Mild cases may cause minimal symptoms and are sometimes discovered incidentally on imaging.
 

Dr. Fried uses a thorough evaluation to determine the type and severity of spondylolisthesis and to guide treatment decisions.

• Medical history: discussion of symptoms, activity level, and any history of trauma or repetitive strain.
   
• Physical and neurological exam: checking posture, flexibility, muscle strength, reflexes, and gait.
   
• Imaging studies:
   
  • X-rays: show vertebral alignment and the degree of forward slippage.
     
  • MRI: reveals nerve compression, disc health, and surrounding soft tissue structures.
     
  • CT scans: provide detailed views of bone structure, especially for planning surgery.
     

Treatment depends on the severity of the slippage, the level of pain or nerve involvement, and the patient’s overall health and goals.
Dr. Fried emphasizes non-surgical care first, with surgery reserved for progressive cases or those with significant neurological symptoms.