Spondylolisthesis

What is spondylolisthesis?

Spondylolisthesis happens when one of the connected bones that form the spine, called the vertebrae, slips forward over the vertebra below it. There are two types of spondylolisthesis:

Isthmic spondylolisthesis starts with a crack in one of the vertebrae, usually at the point at which the lower (lumbar) part of the spine joins the tailbone (sacrum). It may develop as a stress fracture. Because of the constant forces the low back experiences, this fracture does not usually heal as normal bone. In some cases, the cracked vertebra slips forward over the vertebra below it.

Degenerative spondylolisthesis starts with wear and tear on the spinal vertebrae that can happen with age. Over time, the vertebrae – and the joints and ligaments that hold them in place – can become weak and slip out of alignment. Degenerative spondylolisthesis is a common reason for buttock and leg pain and can lead to spinal stenosis.

What are the symptoms of spondylolisthesis?

Isthmic spondylolisthesis may not cause any symptoms for years (if ever) after the slippage has occurred. If you do have symptoms, they may include:

• Pain in the low back and buttocks
• Numbness or tingling
• Pain, muscle tightness, or weakness in the leg (sciatica)
• Increased swayback or limp

Standing, walking, and other activities tend to make symptoms worse, while rest will provide temporary relief.

Studies have shown that 5 to 10 percent of patients seeing a spine specialist for low back pain will have either a spondylosis or isthmic spondylolisthesis. However, because isthmic spondylolisthesis is not always painful, the presence of a crack (spondylosis) and slip (spondylolisthesis) on the X-ray image does not mean that this is the source of your symptoms.

How is spondylolisthesis diagnosed?

Your doctor will begin by taking a history and performing a physical examination, and may order X-ray studies of your back. However, sometimes it is difficult to see a crack and/or slippage on an X-ray image, so additional diagnostic imaging may be needed.

• A computed tomography (CT) scan can show a crack or defect in the bone more clearly.
• A magnetic resonance imaging (MRI) scan may be ordered to clearly show the soft tissue structures of the spine (including the nerves and discs between the vertebrae). It also will show whether the fracture is recent and whether any of the nearby discs have suffered any wear and tear because of the spondylolisthesis.

How is spondylolisthesis treated nonsurgically?

If your doctor determines that a spondylolisthesis is causing your pain, he or she will usually try nonsurgical treatments first. These treatments may include:

• Medication
• Injections
• Lifestyle modifications
• Physical therapy
• Self-care, including rest, exercise, and bracing

If a combination of medication and therapy fails to provide relief, however, your doctor may order additional tests, which will provide greater detail so he/she can plan further treatment.

What are the surgical treatment options for spondylolisthesis?

If conservative treatments do not work, surgery may be considered. Surgery is reserved only for the cases where everything else has been tried or the pain is so severe that you cannot do the most basic of daily activities.

The most common surgical options for spondylolisthesis are spinal fusion surgeries, including:

• Transforaminal lumbar interbody fusion
• Oblique lumbar interbody fusion
• Anterior lumbar interbody fusion
• Posterolateral spinal fusion

Transforaminal Lumbar Interbody Fusion

The goal of a transforaminal lumbar interbody fusion (TLIF) is to relieve the pressure on your spinal nerves and restore spinal stability.

How is a TLIF performed?

• First, your surgeon will make a small incision in the skin of your back over the vertebra(e) to be treated.
• After the spine is accessed, the lamina (the “roof” of the vertebra) is removed.
• The facet joints, which are directly over the nerve roots, may be trimmed to give the nerve roots more room.
• The nerve roots are then moved to one side, and the damaged disc is removed from the front (anterior) of the spine.
• A bone graft is then inserted into the disc space. The bone graft material acts as a bridge, or scaffold, on which new bone can grow.
• Screws and rods are inserted to stabilize the spine while the treated area heals and fusion occurs.
• Your surgeon will then close the incision.

Learn more about TLIF

Anterior Lumbar Interbody Fusion

As with a TLIF, the goal of anterior lumbar interbody fusion (ALIF) is to restore spinal stability. The procedure differs from a TLIF in that the surgeon accesses the spine from the front of the body rather than the back.

How is an ALIF performed?

• First, your surgeon will make a small incision in the skin of your stomach, accessing the vertebra(e) to be treated from the front of the body.
• The damaged disc is removed from the front (anterior) of the spine.
• A bone graft is then inserted into the disc space. The bone graft material acts as a bridge, or scaffold, on which new bone can grow.
• Screws and rods may be inserted from the back to stabilize the spine while the treated area heals and fusion occurs.
• Your surgeon will then close the incision.

Summit Orthopedics offers comprehensive spine expertise

Summit’s spine care team is recognized by the National Committee for Quality Assurance for the comprehensive expertise of our patient-centered care. Our back specialists diagnose spine problems and design custom treatment plans built on a conservative, nonsurgical approach. Most patients find relief through treatments including guided injections, specialized physical therapy, biofeedback, exercise, activity modification, and medication. When conservative care does not relieve symptoms, our highly skilled surgeons offer proven, evidence-based surgical options. Together with you, we will determine the right course of action.

Start your journey to a healthy spine. Find your spine expert, request an appointment online, or call us at (651) 968–5201 to schedule a spine consultation.

Summit has convenient locations across the Minneapolis-St. Paul metro area, serving Minnesota and western Wisconsin. We have state-of-the-art centers for comprehensive orthopedic care in Eagan, MN, Vadnais Heights, MN, and Woodbury, MN, as well as additional community clinics throughout the metro and southern Minnesota.

More resources for you

• Visit our Spine Exercise Libraryfor options to help ease neck and back pain
• See Summit’s treatment optionsfor neck, back, and spine care
• Check out additional information on Summit’s approach to spine care