Spondylolisthesis refers to the forward slippage of one spinal segment – a vertebrae – in relation to the spinal segment immediately below. Approximately 90% of spondylolisthesis cases involve the fifth lumbar vertebrae (also referred to as the L5) being displaced on top of the sacrum. Statistics demonstrate that spondylolisthesis is prevalent in between 3 to 11.5% of the general population, affecting females three times more than males.
Although there are six types of spondylolisthesis, the two most common include ‘IsthmicSpondylolisthesis’ – which more commonly affects younger populations – and ‘DegenerativeSpondylolisthesis’ – which affects elderly populations. The six types are described below:
Dysplastic Spondylolisthesis
Forward displacement occurring due to the absence of certain structures (upper sacrum or L5 neural arch) at birth.
Traumatic Spondylolisthesis
Forward displacement occurring secondary to a fracture at another structure of the vertebrae other than the pars interarticularis.
Pathological Spondylolisthesis
Forward displacement occurring due to bone diseases.
Iatrogenic Spondylolisthesis
Forward displacement occurring after a surgical procedure.
Isthmic Spondylolisthesis
Forward displacement occurring after a stress fracture of a particular structure of the vertebra – pars interarticularis. The stress fracture involved with spondylolisthesis is thought to be a result from repetitive flexion, hyperextension, and rotation of the spine. The forward slippage of the vertebrae may also occur due to an elongation of the pars interarticularis which is caused by repeated trabecular stress fractures and repairs, or from an acute fracture caused by a hyperextension injury.
Degenerative Spondylolisthesis
Forward displacement occurring secondary to degenerative change and remodelling at certain areas of the joint.
Upon assessment, an individual’s spondylolisthesis is graded depending on how far forward vertebrae has slipped on top of the segment below. However, studies show that there is little to no correlation between the degree of slippage and the clinical presentation.
What signs and symptoms are associated with Spondylolisthesis?
The presentations of spondylolisthesis can vary significantly in its severity between individuals.It is estimated that around 30% of individuals may not have any symptoms at all, while others may have mild symptoms or even severe symptoms, including debilitating pain.
The signs and symptoms that are associated with spondylolisthesis are listed below:
Low back, thigh and or leg pain radiating to the buttocks.
Pain increasing with weight bearing or trunk extension
Pain reduced with trunk flexion or lying down
Walking or standing with bent knees
An increased lumbar lordosis – hyperlordosis
Tight low back muscles and/or hamstrings
Limited hip and trunk flexion
Fold or crease in low back
Stiffness due to discomfort
Difficulties with prolonged standing
More severe symptoms may include:
Nerve entrapment (more commonly L5), causing weakness, numbness and/or tingling in one or both legs
Debilitating pain
Walking difficulties
Loss of bowel or bladder control (rare)
Is Spondylolisthesis ‘curable’?
Whether or not spondylolisthesis is ‘curable’ depends on what you define as ‘cured’. From the perspective of decreasing or alleviating the symptoms – absolutely it is curable.
Symptomatic patients with spondylolisthesis are usually advised to take pain relief medication, to discontinue activities that aggravate or contribute to their symptoms, and in some cases surgery may even be recommended.
However, a range of Chiropractic case studies suggest that Chiropractic care and the correction of subluxations via a variety of protocols may impact this condition and offer relief beyond surgery and painkillers.
How can Chiropractic care help with Spondylolisthesis?
Chiropractic care is a highly effective conservative form of management for individuals with spondylolisthesis. With this natural form of management, individuals may not have to undergo painful surgery, or take medication that may have other undesirable effects.
After a comprehensive assessment, Chiropractors may decide to utilise modalities such as spinal manipulation, traction therapy or massage therapy. Spinal manipulation techniques may include specific adjustments of restricted spinal joints, ‘Flexion-distraction technique’ – which involves a gentle pumping action, or low-force mechanically assisted techniques.
The purpose of these modalities are to alleviate pain, to reduce excess load on spinal structures – discs and facets – whilst increasing space in the spinal canal, and to reduce muscle spasms providing increased stability.
When would we refer you out if you have Spondylolisthesis?
In certain cases, when individuals may present with a progressive neurocompressive radiculopathy – lower limb weakness, numbness and tingling – alternative options need to be considered. This may involve bracing to stabilise the lumbar spine, and may include a surgical consultation in more severe cases.
What happens if Spondylolisthesis is left untreated?
In most individuals with spondylolisthesis, the likelihood of progressive slippages is low. However, younger patients – especially under 10 years of age – have a higher risk for progression of spondylolisthesis.
The most common complication associated with any type of spondylolisthesis is nerve root impingement at the level of slippage. In addition, disc degeneration has been found to occur at the level of spondylolisthesis at an increased rate compared to other spinal levels.
What makes Spondylolisthesis worse and things you should not do if you have Spondylolisthesis
The stress fracture involved with spondylolisthesis is thought to be a result of repetitive flexion, hyperextension and rotation of the spine. It is advised to avoid activities that involve repetitive flexion and hyperextension. Adolescents participating in sports requiring these motions, such as gymnastics, football, dancing & weight lifting, are at greater risk.
Tips to manage Spondylolisthesis
Below are six simple tips to help manage the pain and lack of mobility that may be associated with spondylolisthesis
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