Spondylolisthesis is a condition in which an inferior (lower) vertebral body slips forward out of alignment with the next superior (upper) vertebra. Normally, each joint between adjacent vertebrae is supported by two bony facets, one on each side of the joint. The facet joints are in place by ligaments. These ligaments become stressed when excessive force beyond what they can withstand is applied to them.
For example, when you sneeze or cough with poor technique. You might pinch your neck muscles and produce discogenic back pain associated with spondylolisthesis. Because a sudden burst of muscle contraction may cause additional stress on the intervertebral discs. As we age, degenerative changes to the disc space may make them more susceptible to injury. If the vertebrae are not properly aligned, excessive stress can be placed on these ligaments, causing spondylolisthesis.
In spondylolisthesis, one of the vertebrae slips forward a couple of millimeters or so relative to the bone below it. The most common causes of this condition include-
- Congenital defects,
- Trauma (such as an automobile accident),
- Osteoarthritis, and
- Degenerative changes associated with aging.
Spondylolisthesis is often accompanied by osteophyte formation. Osteophytes are a bone growth that develops at a joint due to repetitive trauma caused by abnormal motion over time. This bony outgrowth can also increase stress on the ligaments holding the vertebrae in place, causing spondylolisthesis.
Are you alone with Spondylolisthesis?
This condition becomes more common with age in both males and females. In females the frequency increases from about 10% at birth to 50% by 60 years of age. Spinal segmental instability resulting in symptomatic spondylolisthesis is present in 2-4% of the general population, and may be as high as 12% in athletes. It occurs most often between ages 20-40 years (range 6 months – 80 yrs) and affects men > women (M:F = 1.8:1). It is rare before 6 months of age and rarely over 80 years of age.
The incidence of spondylolisthesis is on the rise in Western societies, due to unidentified factors. It is prevalent in up to 29% of Egyptian mummies. But this represents a very old population study that reflects a different lifestyle than exists today.
The increase may be due to repetitive muscle strains as a result of labor-intensive work or athletic pursuits, genetic risk factors, obesity with increased stress on intervertebral discs, and growth in height (with greater weight loads on the lumbar spine).
Spine deformities such as scoliosis can also increase the likelihood that people will develop spondylolisthesis later in life. Because an already existing spinal deformity increases stress on the spine from abnormal muscle activity and daily stresses.
There are two common words everybody discusses in relation to spondylolisthesis- pars defect and spondylolysis. Have a look on these two.
What is pars-defect?
Pars-defect refers to the presence of a defect (hole or weakness) in the pars interarticularis, which is a part of the joint between adjacent vertebrae.
Acting as a “spacer” that separates one vertebral body from another, it helps maintain proper alignment during spinal movement.
It is possible for spondylolisthesis and pars-defect to coexist—for example, if one bone slips forward while the other remains properly aligned because there’s an area on the posterior side of the normal facet where it has hollowed out, causing flexibility in this spinal segment. This can allow for separation at this level even without major disc degeneration or osteophyte formation.
You might also find out that you have spondylolisthesis and pars-defect- in an x-ray “relates” to something totally unrelated to your back. It can be just pain in the knee or some sense issue with your lower limb and a doctor later points out the defect on your lumbar spine.
In this case, you would likely receive treatment for the pars defect first since it’s less serious than spondylolisthesis. Still don’t overlook the condition. And if your doctor tells you not to worry- change the doctor, opt for a second opinion.
What is the difference between spondylolisthesis and spondylolysis?
Spondylolysis is a defect in one of the vertebrae. It can associate with spondylolisthesis, but there are many people who have spondylolysis without developing spondylolisthesis. Spondylolysis occurs most often at the L5-S1 junction and is frequently asymptomatic (without symptoms). If it does produce symptoms, they tend to resolve within months or years.
Spondylolisthesis includes both the slip of one vertebra forward relative to the next superior vertebra, plus a defect in that uppermost bone—the presence of spondylolysis. For example: if L4 slips forward on top of L5 because of spondylolysis, but there is no accompanying L5 spondylolisthesis; then the person has spondylolysis without spondylolisthesis.
What are the signs and symptoms of spondylolisthesis?
Spondylolisthesis commonly affects the lumbar region of the spine. The pain produced by this condition can be mild to quite severe depending upon how advanced it is.
Mild cases may only produce minor discomfort with occasional aggravation, while more severe cases can produce constant lower back pain that can radiate into your buttocks or legs, resulting in difficulty sitting for long periods of time and difficulty sleeping at night.
In some severe cases, patients may have difficulty walking due to radiating leg pain associated with nerve root compression. In rarest cases, a patient may have difficulty breathing or even lose consciousness due to the compression of a nerve root against the bony vertebral column.
A must-read here because your spondylolisthesis is leading to Sciatica- What makes Sciatica Worse!!
Is Surgery a must for Spondylolisthesis?
Most spondylolisthesis can be treated by nonoperative means.
Don’t miss this case study from Sukhayu- HOW AYURVEDA RESCUED A PATIENT FROM SURGERY WITH SPONDYLOLISTHESIS
The goals of treatment are to reduce pain and functional disability, prevent further progression and avoid surgery. Treatment will vary depending on the cause, severity of disc degeneration or atlantoaxial instability (AAI), response to nonsurgical treatments, patient expectations, and lifestyle factors such as occupation and physical activity level.
The goal in treating lumbar spondylolisthesis is to stop its progress, maintain a good quality of life for the patient and avoid spinal fusion if possible. In cases where conservative therapy fails or produces only short-term relief of symptoms. Conservative treatment may remain to continue with an Ayurvedic approach for Spondylolisthesis treatment. These consist of back strengthening Yoga Asanas along with Panchakarma treatment that increases flexibility while minimizing stress to the lumbar spines.
Risks of Fixation Surgery in spondylolisthesis?
Only advanced cases of spondylolisthesis should go to the Surgery table. Which may be symptomatic from nerve compression or severe deformity.
But, what else a surgeon can suggest to you, other than the surgery? Nowadays, they advise the earliest cases for the surgery. And common people opt for the fixation of the spine. Just because medical insurance covers it?
Spinal fusion involves removing some bone and ligamentous material between the two vertebrae where they meet at the disc space (interbody area) to eliminate instability. Often the height of the spine and size of neck bones are reduced during spinal fusion with plates and screws used to stabilize the spine.
Plates and screws are also used to stabilize the spine in many cases of lumbar spondylolisthesis. The decision whether or not to use them is based on your doctor’s judgment, age of the patient, the severity of the condition, and other factors. And sometimes “greed” of the hospital and surgeon too.
The risks associated with spinal fusion surgery include
- Infection at the site of hardware implant,
- damage to a nerve root that can cause pain,
- weakness or numbness (rare) and
- failure to correct symptoms.
There may be long-term problems related to unstable spines after fusion surgery. These include degeneration of adjacent segments, requiring additional surgery; stress fractures due to excessive mechanical loading of bone graft and potential development of adjacent segmental kyphosis (swayback) requiring orthotic devices.
I have witnessed in my clinical practice that many patients keep on complicating the disease because of the fear of surgery. Don’t worry. Surgery is not the only solution for your spinal problems. But don’t make your problem complicated and dont do mistakes that can complicate your discs.
What are the guidelines of Panchakarma in treating Spondylolisthesis?
The word Panchakarma refers to the five cleansing processes that traditional ayurvedic texts have recommended for over 4000 years, as a part of their overall purification program. While these therapies are classically applied separately and in a specific combination.
These can also help individuals and/or in various combinations for specific indications.
So while there are certain rules about which therapy should go with which disorder; it is possible to mix Panchakarma Therapy using different methods for a single patient who has more than one problem at a time. This therapy is mainly performed by Ayurveda experts under the supervision of Ayurveda experts and experienced Panchakarma therapists.
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