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What is Spondylolisthesis?

A spondylolisthesis happens when one of the spine’s vertebrae (bones) slips forward over the vertebra beneath it. Spondylolisthesis occurs most often in the lumbar spine (low back).

Some people never know they have a spondylolisthesis because they have no symptoms. Symptoms typically include one or more of the following:
• Pain in the low back, thighs and legs
• Weakness in the thighs or legs
• Tight hamstring muscles (back of the thighs)
• Loss of, or difficulty with, bowel or bladder control

There may occur some noticeable physical differences are:
• Stomach sticks out
• Torso looks shorter
• Swayback (low back curves too far inward)
• Waddle when walking

Doctors describe the severity of a spondylolisthesis using a grading scale from 1 to 5. Grade 1 indicates that 25% of a vertebra has slipped forwards over the vertebra below. A Grade 2 indicates a 50% slip, all the way up to a Grade 5, which represents a 100% slip, known as spondyloptosis.

What Causes Spondylolisthesis?
Spondylolisthesis occurs most commonly in the low back, because this region carries most of your body’s weight. More men than women have a spondylolisthesis.

There are two main types of spondylolisthesis - Developmental and Acquired.
Developmental Spondylolisthesis: It is possible to have a spondylolisthesis at birth - this is called Congenital. It can also develop during childhood. Sometimes, though, it is not found until adulthood.
Acquired spondylolisthesis: This can be caused by wear and tear or by forcing your spine to handle physically demanding tasks. Poor ergonomics, carrying heavy things, and strenuous sports (like weight lifting or gymnastics) can all contribute to developing a spondylolisthesis.
Degenerative spondylolisthesis is a form of an acquired spondylolisthesis, and it usually occurs after age 50. Degenerative changes in the spine weaken spinal structures and make the spine susceptible to a spondylolisthesis or other spinal problem.

Your doctor will ask about your current symptoms and remedies you have already tried.

Typical Diagnostic Questions:
• What are your symptoms and when did they start?
• What activities did you recently do?
• What have you done for your pain?
• Does the pain radiate or travel to other parts of your body?
• Does anything reduce the pain or make it worse?

Your doctor will also do detailed physical and neurological exams.
Your doctor might order an x-ray to help diagnose your condition. The x-ray will show the slip of the vertebra over the one beneath it - The Spondylolisthesis. For more information about your spine, your doctor can order a Magnetic Resonance Imaging.

Spondylolisthesis - Non-Surgical Treatments
Most patients will not need any surgical treatment as long as their spondylolisthesis is stable - i.e. it isn’t slipping forward any more. Your doctor will most likely want to monitor your spondylolisthesis at regular intervals.

Non-surgical treatments include:
• Two to three days of bed rest
• Physical therapy
• Low impact exercise - swimming or water walking
• Low back activity restrictions - no strenuous sports (weight lifting, gymnastics, or football), heavy lifting, excessive bending, twisting, or stooping
• Medications to control inflammation, muscle spasm, and/or pain
• A brace to help reduce muscle spasm and pain

Spondylolisthesis - When Surgery is needed
Seldom is spine surgery the first treatment for a spondylolisthesis - first, non-surgical treatment is tried for several months. If non-surgical treatments do not improve your condition, your doctor may recommend surgery. Your spine surgeon will decide which procedure is best for you and how the surgery will be performed.
The goals of surgery are to stabilize the spine and remove pressure on spinal nerves (called decompression). Spinal fusion is the most common surgical procedure. During spinal fusion, two or more vertebrae (bones) are fused together. Spinal fusion uses implants such as screws, rods, cages, and bone graft to help the spine fuse. Advanced technology allows some spondylolisthesis procedures to be performed using minimally invasive techniques.

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