Spondylolisthesis / Anterolisthesis
What is Spondylolisthesis / Anterolisthesis?
Spondylolisthesis is when one of the bones in the spine known as a vertebral body, begins to slip forward or backward over the vertebra beneath it.
Spondylolisthesis is thought to be caused by degeneration of the vertebra or as a result of a high-energy traumatic event. When this happens it causes that segment of the spine to become unstable. This can be quite painful depending on the severity and the surrounding structures impacted. When there is forward slippage of the vertebra it is known as anterolisthesis whereas backward slippage is known as retrolisthesis.
The percentage of the vertebra that has slipped forward or backward out of alignment will dictate what the grading is, with Grade 1 being the most minor; under 25%, and up to grade 4; over 75% of slippage.
How does Spondylolisthesis / Anterolisthesis occur?
The causes of spondylolisthesis can be broken down into five different categories:
Degenerative: spinal joint wear and tear causing degeneration.
Traumatic: a traumatic event which results in immediate slippage or degeneration.
Pathologic: can occur following infection or cancer.
Isthmic: due to a defect in the bone known as ‘pars interarticularis’.
Dysplastic: this occurs when there is a defect during the developmental stage of the vertebrae which changes the structure of the bone, increasing susceptibility for slippage.
Degenerative Spondylolisthesis is more common in adults over 50 years old and most commonly affects the L4-L5 region of the lumbar spine or simply put, your lower back. As the lumbar discs begin to go through degenerative changes, they become more susceptible to repetitive micro-traumas from hyperextension movements. The additional stress placed on the discs during hyperextension can further reduce the vertebral stability and increase the translation or ‘sliding’ of the vertebrae.
What are the symptoms of Spondylolisthesis / Anterolisthesis?
In many cases, people don’t even know they have spondylolisthesis, as minor cases are not likely to cause any discomfort. In more moderate to severe cases, individuals may experience:
tenderness around the affected area,
back stiffness,
increased pain and discomfort when standing or walking for extended periods,
pain when bending forward, and
numbness and tingling in the leg and/or foot.
What should you avoid doing if you have Spondylolisthesis / Anterolisthesis?
Individuals who are diagnosed with spondylolisthesis should minimise high impact activities, extended periods of walking or standing, and heavy lifting movements as extreme pressure on the vertebral bodies have a large amount of compression placed on them, increasing the likelihood of further micro-traumas or slippage.
What treatments are there if you have Spondylolisthesis / Anterolisthesis?
There are surgical and non-surgical options which can be appropriate depending on the severity of the condition.
Non-surgical treatments include:
Medication: over the counter anti-inflammatories may assist with pain relief.
Injections: cortisone injections directly into the affected area have been very successful in relieving pain but is usually only temporary (2)
Physical therapy: exercises tailored towards your condition can help assist with long term pain relief and usually involve targeting back and abdomen strength.
Bracing: commonly used with younger patients to limit spine movement and to allow fractures to heal.
Surgery may be the most suitable option for severe cases of spondylolisthesis where no non-surgical treatments were found to be effective. The surgery aims to relieve the irritated nerve, realign the spinal segments that have slipped, and restore the overall function of the spine (1).
Surgery for spondylolisthesis can be done with or without spinal fusion, depending on what is recommended in your case. After surgery for spinal fusion of two vertebrae, the bones will eventually fuse together and result in limited spinal flexibility in that segment (1)
How can Osteopathy help with Spondylolisthesis / Anterolisthesis?
As Osteopaths we will of course use manual therapy to help relieve tension and increase range of motion but it is also important for us to educate you on your condition as it is important for you to understand what is happening in your body so you will know what you can do to keep it healthy.
We may advise you on how you can develop better habits throughout the day, at work and at home, continuing good posture and adding or removing items to increase ergonomics. Maintaining a healthy weight is also important for patients with this condition to strive towards as increased fat can increase the risk of worsening the condition or preventing healing.
Specific exercises will also be prescribed to increase the strength, flexibility and stability of the spine and further reduce pain and symptoms long term.
Reference:
1. Tenny S, Gillis CC. Spondylolisthesis. [Updated 2021 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430767/
2. Sencan, Savas et al. ‘The Effect of Transforaminal Epidural Steroid Injections in Patients with Spondylolisthesis’. 1 Jan. 2017 : 841 – 846.
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