Spondylolisthesis
by Jennifer Martin, D.P.T.
For a lot of people, the first sign of Spondylolisthesis is back pain. The symptoms of Spondylolisthesis (spondy) may appear suddenly, however the onset of pain is merely a symptom of a spine condition that usually takes time to develop. In spondylolisthesis, a vertebra slips forward on the vertebra below.
If you think of each vertebra like a bony ring, spondy is simply a break down in the normal continuity of the ring.
Imagine the vertebrae of your spine like a stack of bricks. One of the bricks towards the bottom of the stack has a structural break down, and has begun to collapse under the weight of the stack.
With natural forces like wind, load and time, this weakest brick would continue to distort and slip in relation to the bricks around it. This is basically what happens in spondylolisthesis.
Although spondylolisthesis is more common in the low back (lumbar spine), it can occur much less frequently in the neck (cervical spine). This article will explore the most common causes of spondylolisthesis and discuss some of the optional solutions and remedies.
What Causes Spondylolisthesis?
Spondylolisthesis can manifest in a couple of different ways. One type of spondy can occur naturally as a congenital condition, meaning you were born with it. In this case, spondylolisthesis often shows up in the 5th Lumbar vertebra, and it slips forward on the Sacrum (the large triangular bone at the base of the spine).
The second type of spondylolisthesis is the most common, and this is when you have a structural problem with a part of the vertebra called the "pars interarticularis".
Examples of this second type of spondy are degeneration of the vertebra due to arthritic changes and trauma of the spine caused by hyperextension injury from activities such as football, gymnastics, and dance.
This gives you a medical explanation of what happens in spondy, but it doesn't explain "how". The how is a bit more complex. With the exception of congenital spondy, a structural problem with a vertebra does not simply appear for no reason.
The integrity of your vertebra naturally breaks down because of the destructive forces placed upon it over time. This is the real cause of spondylolisthesis. There are many contributing factors - posture, alignment, balance, core strength and nutrition, to name a few.
Here is a real life example of how spondylolisthesis can develop
Let's say that you are a gymnast and have been working on your dismounts. You land with hard impact repetitively for five years. You are also encouraged to finish with "good form", which means arching you back into an extreme position of extension. This position places the vertebrae of your lower back into a compressed and vulnerable position.
You've noticed small aches and pains in your back, but that was nothing compared to the other stiffness and soreness you have experienced in other joints.
One day, you land and you get a sharp, "shocking" pain in your low back. You then begin to notice a "shifting" sensation when you lean over to pick up heavy objects or when you do your dismounts.
These symptoms indicate the development of spondylolisthesis. If not addressed through muscular stabilization, this slippage could lead to nerve damage and more serious issues.
Spondylolisthesis is graded into four levels, depending on the amount of slippage of the vertebra.
Grade I - 0-25 %
Grade II 25-50%
Grade III 50-75%
Grade IV 75-100%
Common Remedies and Solutions
The first and most effective option for spondylolisthesis is to stabilize the lower back or neck with appropriate exercises. Secondly, learning correct body mechanics and postural alignment will help significantly.
There are also the usual medical options such as NSAIDs, epidural injections and surgery. The surgical solution for spondy is spinal fusion, which involves placing hardware in the spine to stabilize the segment/s involved. Surgery always involves the risk of complications, risks and side affects.
