Slippage of vertebral bodies is known as spondylolisthesis. This can occur anywhere within the spinal column, but is most common in the lumbar (low back) spine. There are six different types of spondylo-listhesis that can occur. These include congenital, isthmic, degenerative, traumatic, pathologic and iat-rogenic.
refers to a slippage or displacement of one vertebral body in relationship to the one below it that has been present since birth. This results from abnormal bone formation
results from a condition known as spondylolysis. A fracture in the pars inter-articularis, usually during childhood or adolescence, can lead the bones to slip. High impact sports such as gymnastics, heavy weightlifting and football can lead to excessive stress (hyperextension) on the low-er spine causing a stress fracture. The fifth lumbar vertebrae is most commonly affected.
is typically seen in individuals over 50 years old as a result of disc de-generation that leads to facet arthritis and eventual weakening of the ligamentum flavum.
A traumatic spondylolisthesis
results from a significant injury. A fracture develops in one or more parts of the vertebra such as the facet joints which leads to instability.
refers to a vertebral tumor, infection, or other disease process that weak-ens the bone, causing a fracture and slippage.
Iatrogenic or post-surgical spondylolisthesis
can result from having back surgery. Removal of bone (laminectomy) can weaken a vertebral segment and lead to instability and slippage.
The degree of spondylolisthesis is determined by the amount of slippage present. A slip of 25% or less is classified as a Grade I. 26-50% is a Grade II, 51-75% is a Grade III, greater than 75% is a Grade 4.
In many patients, a spondylolisthesis is present, but not there are no symptoms. Others complain of significant back and/or leg symptoms. Spasms to the low back are commonly associated with certain types of spondylolisthesis. More significant slips can cause numbness and weakness to the legs.
The physical examination of a patient with a spondylolisthesis may reveal neurologic deficits including reflex loss, loss of motor function, and loss of sensation. The diagnosis is commonly confirmed by x-rays and other imaging studies such as an MRI or CT scan.
Treatment for spondylolisthesis is dependent upon a number of factors including patient’s level of dis-comfort, age, neurologic status, other interrelated spinal issues, and medical co-morbidities. Options may range from observation of the condition with follow-up x-rays to other conservative treatments including exercise, medications, and injections. More severe cases with neurologic involvement may require surgery.