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Adult Spondylolisthesis in the Low Back

Spondylolisthesis is a condition of the spine characterized by the forward displacement of a vertebra over an underlying vertebra. Degenerative spondylolisthesis is a type of spondylolisthesis that occurs as a result of degenerative or age related changes to the spine. The condition most commonly affects the lumbar spine (low back).

Degenerative disc disease and spondylosis damage the structures of the spine, including the bones, joints, and the ligaments.  A back injury, excess body weight, poor posture, or repetitive motions can aggravate degenerative spondylolisthesis.

Symptoms

The main symptoms of degenerative spondylolisthesis include low back pain or neck pain, sciatic pain, weakness in the legs, tightness of the hamstrings (leg muscles), muscle spasms, abnormal gait, and rarely loss of bowel or bladder control.

Diagnosis

An accurate diagnosis of degenerative spondylolisthesis and an effective treatment plan are important for a successful treatment outcome. Your doctor will diagnose the condition based on your symptoms, medical history, family history and physical examination. A neurological examination is also required to test your reflexes, muscle strength, and sensations. Your doctor may also recommend diagnostic tests such as an x-ray, computed tomography (CT) scan or magnetic resonance imaging (MRI). X-ray of the spine may help to assess the position of the vertebrae. A MRI scan may be needed to identify the nerve or spinal canal compression.

Grades of spondylolisthesis

The Meyerding Grading System is the most common grading system used to classify the degree of vertebral slippage. Your doctor would grade your Spondylolisthesis with the help of spinal X-rays.

  • Grade I  indicates 1 % to 24 % slip of the vertebral body
  • Grade II indicates 25% to 49 % slip
  • Grade III indicates 50 % to 74 %
  • Grade IV indicates 75 % to  99 %
  • Grade V is a complete slip (100%), known as spondyloptosis

Treatment

Most cases of degenerative spondylolisthesis are managed with non-surgical treatments without the need for a surgery. The non-surgical treatment options include a short period of rest, activity modification, anti-inflammatory and pain medications, muscle relaxants, spinal injections, bracing, physical therapy, and acupuncture. Your doctor may recommend a combination of one or two treatment options to increase the success of your treatment.
In a majority of the patients, degenerative spondylolisthesis can be managed with conservative treatment. Surgery may be considered in the following conditions:

  • The vertebra continues to slip
  • Neurologic problems
  • Pain not relieved by non-surgical treatment

The aim of the surgery is alleviate the pressure over the nerve and provide stability to the spine. Spinal stabilization and fusion are common procedures performed to halt progression of the disease and stabilize the spine, during the healing process. A minimally invasive spine surgery may be required for patients with neurological problems.

Degenerative spondylolisthesis can progress and worsen over time; hence, regular follow up with your doctor is important to monitor your condition and treatment outcome. Most people fully recover and return to a healthy, pain free, active lifestyle. Your doctor is a reliable source to answer your queries regarding degenerative spondylolisthesis.

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Houston Back and Spine Specialists

Advanced Orthopedics and sports medicine has Board Certified/Eligible physicians who are thoroughly educated in the latest treatment techniques both surgical and conservative. The spine surgeons practice conservatively utilizing minimally invasive techniques whenever possible. Should surgery be required, options range from out-patient spinal surgery to major spinal reconstruction and management of scoliosis.

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