What Is Spondylolisthesis? Causes, Diagnosis, and Treatment Options Near You in New Jersey and Florida
If a person is dealing with pain, stiffness, and weakness in the back, it may be due to spondylolisthesis, a condition that causes abnormal spine alignment. Fortunately, treatment is available at Centers for Neurosurgery, Spine & Orthopedics (CNSO), New Jersey’s and Florida’s most comprehensive brain and spine center. CNSO provides multidisciplinary medical care for various types of nerve, brain, and spinal conditions, including spondylolisthesis, near you in New Jersey and Florida. Explore this condition, its causes and symptoms, and the diagnosis and treatment process.
Key Takeaways
- Spondylolisthesis is a spinal condition where one or more vertebral bones in the spine slide forward or backward relative to the vertebral bones above and below it, creating abnormal spine alignment, compressing the spinal cord, and causing symptoms such as pain, weakness, stiffness, and loss of mobility.
- Spondylolisthesis is categorized into grades using the Meyerding Grading System, which measures the degree of forward slippage out of alignment with the other vertebral bones. Grade I is the mildest form, while Grade V is the most severe.
- There are several types of spondylolisthesis, including degenerative, isthmic, traumatic, and pathologic.
- Diagnosing spondylolisthesis involves a thorough physical examination and imaging scans, including standing X-rays and magnetic resonance imaging (MRIs).
- Low-grade spondylolisthesis can be treated with conservative measures like activity modification, physical therapy, and medication, while high-grade spondylolisthesis requires surgical treatment.
What Is Spondylolisthesis, and How Does It Develop?
Spondylolisthesis is a condition in which a vertebra in the spine slides forward or backward relative to the vertebra next to it, creating abnormal spine alignment.
In a normal spine, the vertebral bones are aligned in a graded curve with one another, providing the support and structure necessary to protect the spinal cord, allow for agile movement, and sustain the weight of the upper body. A vertebral bone can slide forward or backward relative to the vertebra next to it, out of spinal alignment because of a high-impact injury or spinal ligament laxity, resulting in spondylolisthesis. When the vertebra slips toward the front of a patient, it is called anterolisthesis. When it slips backward, it is referred to as posterolisthesis.
Spondylolisthesis can cause spinal cord compression, which results in myelopathic symptoms, such as imbalance, weakness, bilateral loss of extremity function and use, and/or incontinence. Spondylolisthesis can also cause bilateral nerve roots of the spine to become pinched or irritated, which can result in pain, tingling, and numbness that travel away from the point of compression into the extremities (radiculopathy). The condition can happen anywhere along the spine, but most commonly occurs along the lumbar spine (lower back).
The Meyerding Grading System Explained
When a patient is diagnosed with spondylolisthesis, they are given a grade from a scale called the Meyerding Grading System. It has five grades that each measure the degree of forward slippage (anterior translation) of one vertebra over the vertebra below it. It is used to help doctors communicate the level of spinal alignment and develop appropriate treatments.
Grade and Symptom Comparison
|
Grade |
Slippage |
Symptoms |
Recommended Approach |
|
I |
0% to 25% |
No symptoms or mild discomfort |
Activity modification, physical therapy, and anti-inflammatory pain management |
|
II |
25% to 50% |
• Lower back pain • Tight leg muscles • Nerve pressure that can make standing or walking difficult |
Activity modification, physical therapy, bracing, and anti-inflammatory pain management |
|
III |
50% to 75% |
• Intense lower back and leg pain • Tight hamstrings • Muscle weakness • Trouble walking or standing for long periods • Spinal instability |
Often surgery, although physical therapy, bracing, and anti-inflammatory pain management may also be used |
|
IV |
75% to 100% |
• Severe low back pain • Shooting leg pain or sciatica • Tight hamstrings • Changes in gait • Deep nerve compression leading to numbness or weakness |
Surgery like surgical decompression, spinal fusion, and spinal realignment |
|
V |
Fully out of alignment |
• Intense, chronic back pain • Visible physical deformity • Major nerve compression • Extreme muscle weakness |
Spine surgery, such as spinal fusion, decompression, or realignment |
What Are the Symptoms of Spondylolisthesis?
Many people with spondylolisthesis do not experience any symptoms and do not know they have it. If a person does experience symptoms, they may include:
- Dull or sharp pain in the lower back, which may worsen during movement
- Radiating pain that travels from the lower back to the legs and buttocks (sciatica)
- Stiffness or tightness in the hamstrings
- Numbness and tingling
- Weakness in the feet and legs, especially after standing for a long time
- Posture changes
The symptoms may vary depending on where the misaligned vertebrae are (lumbar or cervical spine). If a person experiences red-flag symptoms, such as a loss of bowel or bladder control, or loss of movement of an extremity, they should seek immediate medical attention.
What Are the Types of Spondylolisthesis?
Spondylolisthesis is typically categorized into types, which are based on the underlying cause of the slippage. They include:
- Degenerative: This form is the result of degenerative changes, whether from aging, arthritis, or the wear of discs and joints over time. It is the most common type and often occurs in older adults (especially women) at the L4-L5 level in the lumbar spine.
- Isthmic: This type is the result of a crack or stress fracture in a small segment of bone called the pars interarticularis (pars defect). It typically impacts teens or athletes involved in repetitive hyperextension, such as gymnastics or football, at the L5-S1 level.
- Traumatic: This type is caused by a sudden, high-impact injury, such as a hard fall or car accident, causing parts of the vertebra to fracture and move out of alignment.
- Pathologic: This type is the result of weak bones from an underlying illness, such as a tumor, infection, or severe osteoporosis, that has affected the bone structure.
Determining the type of spondylolisthesis is important to determine the most suitable treatment plan and address any underlying causes.
Pars Defects, Pars Fractures, and Spondylolysis
Spondylolysis, a similar condition to spondylolisthesis, is a stress fracture or small crack in the pars interarticularis, a thin piece of bone that connects the vertebrae in the spine. Spondylolysis is also known as a pars defect or pars fracture.
When a pars defect occurs on both sides of the bone, it disconnects the front and back parts of the vertebra. When this solid connection is lacking to maintain alignment, gravity and body weight can cause the upper bone to slip forward over the bone below it (spondylolisthesis). When spondylolisthesis occurs from a pars defect that causes noticeable symptoms, treatment is often necessary to help improve comfort and overall quality of life. If a pars defect is asymptomatic and does not cause spondylolisthesis or another condition, it can typically be monitored without active treatment.
Where Does Spondylolisthesis Occur?
Spondylolisthesis can occur anywhere along the spine, but it is most common in the lumbar spine (lower back). Lumbar spondylolisthesis often affects the bottom levels, like the fourth and fifth lumbar vertebrae (L4-L5) or where the spine meets the sacrum (L5-S1). Patients with lumbar spondylolisthesis may experience lower back pain, tenderness, decreased flexibility, tight hamstring muscles, radicular pain down the legs, and gait imbalances. An appropriate treatment plan will be developed by a neurosurgeon or an orthopedic spine surgeon, considering the patient’s severity of symptoms and the degree of malalignment revealed on the lumbar MRI.
Cervical spondylolisthesis is less common, but it occurs when the slipped vertebra is in the cervical region (neck). It causes symptoms such as neck pain, tight muscles, sharp pain that shoots into the shoulders or arms, weakness in the hands, and even balance issues. An appropriate treatment plan will be developed by a neurosurgeon or an orthopedic spine surgeon, considering the patient’s severity of symptoms and the Meyerding Grade visualized on the cervical MRI.
How Does CNSO Diagnose Spondylolisthesis?
To diagnose spondylolisthesis, the multidisciplinary team at CNSO will utilize a comprehensive diagnostic process. It includes:
Physical Exam
The spine specialist will meet with the patient to discuss their medical history and symptoms and examine their spine. They will assess the patient’s spinal alignment, posture, gait, and range of motion to identify any issues or see if certain movements cause pain, numbness, or weakness. The specialist will also look for abnormal neurologic signs by testing balance, gait movement, upper and lower extremity motor strength, reflexes, and sensation.
Imaging Scans
To visualize the vertebrae and look for the degree of malalignment and slippage, imaging scans are used. Options that may be used include:
- Standing X-rays: These scans, taken from the side view (lateral), can show the forward slip of a vertebra, while flexion-extension X-rays (bending forward and back) help assess spinal instability.
- Magnetic resonance imaging (MRI): These scans can show soft tissues and discs to determine whether the displaced bone compresses or irritates surrounding nerves.
- Computed tomography (CT): These scans provide detailed cross-sections of bone structures in the spine to help identify pars fractures that can result in spondylolisthesis.
During this process, the CNSO team can confirm or rule out a diagnosis of spondylolisthesis. If it is confirmed, they will give the patient a grade from I to V that gauges its severity.
What Are the Non-Surgical Treatments for Spondylolisthesis?
Patients with Grade I or II spondylolisthesis often see effective symptom relief and improvement from conservative, non-surgical treatment methods. They include:
- Activity modification: The patient may be directed to limit high-impact sports, intense twisting, or heavy lifting that can stress the lower back and aggravate symptoms.
- Physical therapy: Using targeted therapeutic exercises, a physical therapist will help the patient strengthen the core and lower back muscles, improve flexibility, and reduce pressure on irritated spinal nerves.
- Bracing: Wearing a back brace temporarily during pain flare-ups can help limit movement and reduce resulting pain.
- Medications: To reduce pain and inflammation from spondylolisthesis, nonsteroidal anti-inflammatory drugs (NSAIDs) are often recommended. Muscle relaxants may also be used for patients with severe spasms, while nerve medications can help relieve nerve irritation.
- Steroid injections: If oral medications do not effectively relieve pain, targeted corticosteroid injections into the epidural space can help provide more targeted relief by reducing swelling and inflammation of the nerves and spinal cord.
At CNSO, the team takes a conservative approach to treatment, trying a variety of non-surgical treatments before turning to surgical procedures. Each doctor considers whether a medically proven, evidence-based, non-invasive technique can effectively treat the patient before resorting to surgery.
When Does Spondylolisthesis Need Surgery?
Low-grade spondylolisthesis typically does not need surgery, but higher grades, such as Grade III, IV, and V, do. Low grades may also need surgical treatment if conservative treatments fail after six months or nerve compression starts to cause severe deficits. Surgical procedures to treat spondylolisthesis may include:
- Transforaminal lumbar interbody fusion (TLIF): This is a type of spinal fusion surgery in which the surgeon removes a damaged spinal disc, inserts a spacer cage with a bone graft, and fuses the bones using metal screws and rods. It is used for spondylolisthesis in the lumbar spine and involves approaching the spine through the intervertebral foramen.
- Posterior lumbar interbody fusion (PLIF): This is a similar surgery to TLIF, but it approaches the spine from the back of the body.
- Anterior lumbar interbody fusion (ALIF): This is also similar to TLIF and PLIF, but the surgeon approaches the spine from the front of the body. It may be used to better correct abnormal spinal alignment or to insert a much larger bone graft spacer for added stability.
Spinal fusion surgeries like TLIF, PLIF, and ALIF are commonly used to treat spondylolisthesis, but research has shown that decompression surgeries, such as laminectomies, may be just as effective for stable low-grade spondylolisthesis and therefore not require a fusion. The CNSO surgeons will weigh the pros and cons of each surgery to determine the best option for each patient’s condition, treatment goals, and overall health.
Find Expert Spondylolisthesis Treatment Near You in New Jersey and Florida
If spondylolisthesis is affecting a person’s comfort and quality of life, they deserve comprehensive and compassionate treatment. Patients in New Jersey and Florida can access it at Centers for Neurosurgery, Spine & Orthopedics, which is staffed by an experienced team of neurosurgeons, orthopedic spine surgeons, interventional pain management physicians, physiatrists, rehabilitation specialists, and certified physical therapists.
CNSO has office locations across New Jersey or Florida, so patients can be seen where it is most convenient. To learn more about spondylolisthesis treatment near you, contact CNSO today.
Frequently Asked Questions About Spondylolisthesis
What is spondylolisthesis?
Spondylolisthesis is a condition in which a vertebra in the spine slides forward or backward relative to the vertebra next to it. This creates abnormal spine alignment, often resulting in pain, weakness, or posture changes.
What is the difference between spondylolysis and spondylolisthesis?
Both spondylolysis and spondylolisthesis are spine conditions. However, spondylolysis refers to a stress fracture or crack in a small spinal bone called the pars interarticularis. Spondylolisthesis is a condition that occurs when the spine is misaligned or unstable, allowing the vertebra to slip forward or backward relative to the bone below it.
What is a pars defect?
A pars defect is the same as spondylolysis. It is a fracture or crack in a small bone that connects the vertebrae, called the pars interarticularis.
What is Grade I spondylolisthesis vs. Grade IV?
Grade I spondylolisthesis is the mildest form, where there is 0% to 25% slippage and mild symptoms (or no noticeable symptoms). Grade IV is one of the most severe forms, where there is 75% to 100% slippage and symptoms like severe low back pain, sciatica, tight hamstrings, nerve compression, and gait changes.
Can spondylolisthesis heal on its own?
Spondylolisthesis does not heal on its own, meaning the vertebral body that is out of alignment does not return to an aligned position without surgery. However, pain and inflammation caused by spondylolisthesis can be eliminated with conservative measures like rest, physical therapy, and medications.
What activities should someone avoid with spondylolisthesis?
People with spondylolisthesis should avoid activities like high-impact sports or aerobics, back extensions, heavy lifting, and spinal twisting, as they can increase vertebral instability.
When does spondylolisthesis need surgery?
Spondylolisthesis typically requires surgery when:
- Conservative treatments fail after six months
- Nerve compression leads to severe deficits
- Spinal cord compression occurs
- The spinal slip is high-grade
What is TLIF surgery for spondylolisthesis?
Transforaminal lumbar interbody fusion (TLIF) is a procedure in which the surgeon removes a damaged spinal disc, inserts a spacer cage with a bone graft, and fuses the bones together using metal screws and rods. The surgeon approaches the spine through the intervertebral foramen, rather than the back or the front.
What is the recovery time after spondylolisthesis surgery?
Recovery time will depend on the type of procedure received, but it generally takes six weeks, sometimes up to twelve weeks, depending on age, for a return to light activities. For a fusion of bone, meaning the full amount of bone regrowth to occur, it may take up to six months to twelve months.
Is spondylolisthesis a disability?
Spondylolisthesis is not automatically considered a disability, but it may be considered one if it is severe enough to prevent the person from working full time in their profession.
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