Understanding Isthmic Spondylolisthesis

Spine surgeon reviewing imaging results with patient with spondylolisthesis

In the spine, the pars interarticularis bone is nearest the joining of the lower facet joint to the upper facet joint. When a defect or fracture is present in this bone, it can cause one vertebra to slip forward over the vertebra below it. This is a condition known as isthmic spondylolisthesis. At Centers for Neurosurgery, Spine & Orthopedics (CNSO) the surgeons treat isthmic spondylolisthesis, how it is diagnosed, and treatment options.

What Is Isthmic Spondylolisthesis?

Isthmic spondylolisthesis is a condition in which one vertebra slips forward or over the vertebra below it. This condition is caused by a defect, or fracture, of the pars interarticularis, a bone that connects the upper and lower facet joints.

Signs and Symptoms

Because isthmic spondylolisthesis can result in spinal instability, the condition can produce a range of symptoms. These include:

  • Abnormal limp or gait
  • Muscle spasms
  • Pain in the lower back
  • Sciatica (any numbness, weakness, tingling, or pain radiating down the leg, along the sciatic nerve path)
  • Tight hamstrings
  • Weakness in the legs

Some patients don’t experience pain with isthmic spondylolisthesis, though others are severely impacted when it comes to quality of life.

Causes and Risk Factors

Several circumstances can result in isthmic spondylolisthesis. The condition often is attributed to accumulated spinal stress or overuse injuries resulting in a fracture in the pars interarticular bone. Sometimes, it is the result of a birth defect that causes the improper formation of that same bone

Risk factors for isthmic spondylolisthesis include:

  • Being a young athlete
  • Family history of the condition
  • Frequent heavy lifting
  • Repeated twisting or stooping over
  • Sports that cause considerable spinal stress, such as football, gymnastics, and weightlifting

Diagnosing and Classifying Isthmic Spondylolisthesis

Patients typically are referred to a spine specialist, such as a neurosurgeon or orthopedic spine surgeon by their primary care physician or general orthopedic doctor. The team of experts at CNSO offers a more thorough analysis of the cause of the back pain through their utilization of comprehensive diagnostic examination and imaging to further evaluate the patient’s condition.

To confirm a diagnosis of isthmic spondylolisthesis, patients are evaluated with the following diagnostic methods:

  • Medical history assessment: A patient’s unique medical history can hold clues to an underlying cause or genetic factors to consider for their condition.
  • Physical examination: The patient is physically examined for signs of isthmic spondylolisthesis or other spinal conditions, such as loss of sensation or reflexes and muscle weakness.
  • Imaging tests: To visually identify isthmic spondylolisthesis, patients may undergo imaging tests such as X-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI).

Isthmic spondylolisthesis can range from mild to severe, which is why the condition is classified into grades. Using the Meyerding Grading System, slips receive a grade that correlates with how far the affected vertebra has slipped forward over the vertebra beneath. Grades are measured in percentages and include:

  • Grade I: 1-24% slip
  • Grade II: 25-49% slip
  • Grade III: 50-74% slip
  • Grade IV: 75-99% slip
  • Grade V: 100% slip (known as spondyloptosis)

Conservative and Surgical Treatment Options

Many considerations are made when forming a patient’s treatment plan at CNSO. For isthmic spondylolisthesis cases, the severity and degree of the slip, the patient’s overall health, and the individual’s treatment preferences all are considered.

CNSO, the most comprehensive spine center in New Jersey, bases all personalized treatment plans on a conservative approach. The team consists of award-winning neurosurgeons, spine surgeons, pain management specialists, and physical medicine and rehabilitation physicians. These medical professionals first consider whether a medically proven, evidence-based, non-invasive technique would ultimately best treat the patient.

Non-Surgical Treatment Options

Most isthmic spondylolisthesis cases are treated non-surgically. A patient’s treatment regimen can include:

  • Alternative therapies (i.e., acupuncture)
  • Bracing
  • Chiropractic care and spinal manipulation
  • Epidural steroid injections
  • Lifestyle improvements such as losing weight and limiting strenuous activities
  • Oral corticosteroids
  • Muscle relaxants
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Physical therapy (available at CNSO’s Jersey City, Paramus, and Wayne, NJ, locations)
  • Short-term bed rest and activity modification

Surgical Treatment Options

If non-surgical modalities fail to provide relief, or if the patient’s condition is severe enough to warrant an operation, spine surgery may then be considered. Procedures that treat isthmic spondylolisthesis include:

Trust CNSO for Isthmic Spondylolisthesis Care

The dedicated surgical and non-surgical team at CNSO understands how isthmic spondylolisthesis can impact daily life. By working with leading board-certified neurosurgeons, orthopedic spine surgeons, interventional pain management physicians, physiatrists, rehabilitation specialists, and certified physical therapists, patients receive comprehensive and coordinated treatment for spondylolisthesis and its causes.

CNSO offers multiple convenient locations across northern New Jersey, including Bergen, Passaic, Essex, Morris, and Hudson counties. To learn more about effectively treating isthmic spondylolisthesis pain and symptoms, contact CNSO today.

Centers for Neurosurgery Spine & Orthopedics