What is Spondylolisthesis?
Spondylolisthesis is a defect or fracture of part of the vertebral bone called the pars interarticularis. It usually occurs in the lumbar region. Spondylolisthesis (Low Back) is a forward slippage of one vertebral body on top of another.
Spondylolisthesis are of two type :
1) Developmental - This is due to defect or weakness in the bony restraints from birth. When the defect is more it presents as high grade listhesis in early teens. When the defect is less it presents at 30 to 40 years as low grade spondylolisthesis.
2) Acquired Causes are the other group of causes due to trauma following surgery or disease etc.
What are the symptoms of spondylolisthesis?
Most people with spondylolisthesis have slow onset of symptoms. The common symptoms may include:
Low back pain
Feeling of tightness in the back of thighs
Pain radiating down the legs
Difficulty with upright posture and gait
Why do patients with spondylolisthesis have pain?
Patients have pain in the back because of the unstable movement of the vertebra. Leg pain is because of pressure on the nerves.
What is the treatment for spondylolisthesis?
The patient may be treated surgically or non-surgically. Treatment can only be decided after thorough examination and investigations. Every patient will have to be individually evaluated and after considering the extent of the spondylolisthesis, age of the patient, presence of medical conditions and expectations of the patient. Only then can a treatment protocol be decided.
What is the non-operative treatment of Spondylolisthesis?
Most patients with spondylolisthesis have acute episodes of pain with intervening pain free periods.
These symptoms usually improve with rest and time.
To help relieve the pain, treatment may include:
Patients may also be given a small injection (epidural steroid) into the spine for pain relief.
When is surgery required?
Patients who have one or more of the following symptoms may require surgery.
Worsening of back pain or persistent leg pain with no improvement even with adequate rest and pain killers.
Weakness of the legs,
Disturbance of bowel or bladder function
Progressive forward slipping of the vertebra.
What will be done during the surgery?
The goals of surgery are
To prevent further slipping of the vertebra
To relieve the pressure on the spinal nerves
This will require stabilization of the spine with rods and screws as well as decompression of the nerve roots. We usually put a spacer in the disc space with bone graft.
What are the types of surgery for spondylolisthesis?
Posterior Instrumentation and Fusion- Fusion is the surgery by which the two abnormally moving vertebrae are joined and become a single unit. Instrumentation (stabilization) is the use of metal screws and rods to hold the vertebrae in position till they fuse. Fusion is achieved by placing a bone graft over the back of the vertebrae.
Posterior Lumbar Inter-body Fusion (PLIF)
In some patients, additional stabilization of the spine is required. So in addition to posterior instrumentation and fusion, metalcage/peek cage are placed in between the vertebral bodies to achieve a solid fusion.
Anterior and Posterior Surgery
In severe spondylolisthesis, it may be necessary to operate the patient from the front as well as the back.
What is the post-operative protocol?
In most cases patients will be ready to walk within the first few days of surgery. Following this a physiotherapist will be there to assist you to start walking and then proceed to spine strengthening exercises. You will be instructed to follow a home program of activity and exercises and asked to come for regular followup.