Spondylolisthesis

In addition to being a multi-sylabbic word, spondylolisthesis is defined as an anterior (forward) displacement of a vertebra, in relation to the vertebra immediately below it.  Spondylolisthesis can lead to a deformity of the spine, as well as a narrowing of the spinal canal or irritation of the exiting nerve roots. Approximately 5-6% of males and 2-3% of females have a spondylolisthesis. It usually appears in people who are involved with very physical activities, such as weightlifting, gymnastics, or football. Males are more likely than females to develop symptoms of this disorder, since they generally engage in more strenuous physical activities. Many people with a spondylolisthesis will have no symptoms, and will only become aware of the problem when it is revealed on an x-ray for a different condition. There are several types of spondylolistheses. The most common is spondylolysis of the pars interarticularis, which is found in younger individuals. Another type is degenerative, which occurs in older patients. The vast majority of spondylolistheses are found in the low back, with rare occurrences in other spinal regions. Most spondylolistheses, seen before the age of 50, are due to a break in the pars, which occurred during childhood or adolescence (often during athletic activities requiring low back extension). When symptoms occur after the age of 50, a degenerative cause is more likely.

Symptoms of a spondylolisthesis may include; pain in the low back, especially after exercise, increased lordosis (i.e., swayback), pain and/or weakness in one or both thighs or legs, reduced ability to control bowel and bladder functions and tight hamstring musculature. A “waddle” may be seen in more advanced causes, due to compensation of the muscles.

There are several different types of spondylolisthesis. The more common types include: Congenital spondylolisthesis — Congenital means “present at birth.” Congenital spondylolisthesis is the result of abnormal bone formation. In this case, the abnormal arrangement of the vertebrae puts them at greater risk for slipping.  Isthmic spondylolisthesis — This type occurs as the result of spondylolysis, a condition that leads to small stress fractures (breaks) in the vertebrae. In some cases, the fractures weaken the bone so much that it slips out of place. Degenerative spondylolisthesis — This is the most common form of the disorder. As the body ages, the discs, which are the cushions between the vertebral bones, lose water and become less spongy and less able to resist movement by the vertebrae.

Diagnosis usually includes a comprehensive physical exam and an X-ray of the lower back. A computed tomography (CT) or magnetic resonance imaging (MRI) scan, which produce more detailed images, might be needed to more clearly see the bones and nerves involved.

Response to chiropractic care is very often excellent. Studies have shown that when a spondylolisthesis is found in an adult, specific adjustments to the dysfunctional joints are quite effective, and that the prognosis is not significantly different from other patients. The main goals of chiropractic care, for treating spondylolisthesis, are to optimize good spinal mechanics and to improve posture and alignment. Chiropractors do not reduce the slippage of spondylolisthesis. Instead, they address the spinal joints above and below the slipped vertebra—helping to address the biomechanical causes of spondylolisthesis. This can help relieve low back pain and improve motion in the region. In addition to spinal manipulation and manual therapy techniques, the chiropractor may also use various therapy modalities to help reduce inflammation caused by conditions associated with spondylolisthesis. An important approach to the treatment of patients with spondylolisthesis is to strengthen and re-coordinate the deep support muscles of the low back. The chiropractor will attempt to improve the dynamic stability and segmental control of the spine. Exercises to train the co-contraction patterns of these muscles are often called “spinal stabilization” exercises. Specific maneuvers include: posterior pelvic tilt, lower abdominal hollowing and abdominal bracing. Corrective spinal care and exercises can help minimize hyperlordosis (sway back) and also help address inflammation and pain caused by spondylolisthesis. Another important consideration, for long-term support of the spondylolisthetic spine, is the use of custom-made orthotics. Since many of these patients have low or absent arches in their feet, the additional support from a pair of custom-made orthotics is frequently necessary.

Although spondylolisthesis might not be preventable, there are steps you can take to reduce the risk of slips: 1. Keep your back and abdominal muscles strong to help support and stabilize the lower back. 2. Choose activities and sports that do not place your lower back at risk for injury. Swimming and biking are possible options. 3. Maintain a healthy weight. Excess weight puts added stress on your lower back. 4. Eat a well-balanced diet to keep your bones well-nourished and strong.