Spondylolisthesis

spondylolisthes What is spondylolisthesis?
Spondylolisthesis is a condition in which one bone in your back (vertebra) slides forward over the bone below it. It most often occurs in the lower spine (lumbosacral area). In some cases, this may lead to your spinal cord or nerve roots being squeezed. This can cause back pain and numbness or weakness in one or both legs. In rare cases, it can also lead to losing control over your bladder or bowels. See a doctor right away if you begin losing bladder or bowel control.
Sometimes when a vertebra slips out of place, you may have no symptoms at all or no symptoms until years later. Then, you may have pain in your low back or buttock. Muscles in your leg may feel tight or weak. You may even limp.

What causes spondylolisthesis?
The bones in your spine come together at several small joints that keep the bones lined up while still allowing them to move. Spondylolisthesis is caused by a problem with one or more of these small joints that allows one bone to move out of line.

Spondylolisthesis may be caused by any of a number of problems with the small joints in your back. You could have:
• A defective joint that you've had since birth (congenital).
• A joint damaged by an accident or other trauma.
• A vertebra with a stress fracture caused from overuse of the joint.
• A joint damaged by an infection or arthritis.
Spondylolisthesis affects children and teens involved in sports. Some sports, such as gymnastics or weight lifting, can overuse back bones to the point of causing stress fractures in vertebrae, which can result in spondylolisthesis.
Older adults can develop spondylolisthesis, because wear and tear on the back leads to stress fractures. It can also occur without stress fractures when the disc and joints are worn down and slip out of place.

What are the symptoms?
Symptoms of spondylolisthesis may include:
• Back or buttock pain.
• Pain that runs from the lower back down one or both legs.
• Numbness or weakness in one or both legs.
• Difficulty walking.
• Leg, back, or buttock pain that gets worse when you bend over or twist.
• Loss of bladder or bowel control, in rare cases.
Sometimes spondylolisthesis causes no symptoms at all.

TREATMENT:
Non-surgical treatment for adult patients with an isthmic spondylolisthesis is similar to that for patients with low back pain and/or leg pain from other conditions and may include one or a combination of:

1) Medications Pain medications, such as acetaminophen, and/or NSAID’s (e.g. ibuprofen, COX-2 inhibitors) or oral steroids to reduce inflammation in the area.

2) Heat and/or ice application, to reduce localized pain.Generally, ice is recommended to relieve pain or discomfort directly after an activity that has caused the pain. Heat application is recommended to relax the muscles, and promote blood flow and a healing environment.

3)Physical Therapy Stretching is recommended, beginning with hamstring stretching and progressing over time. In addition, special attention should be paid to stretching the hamstrings twice daily in order to alleviate stress on the low back. The exercise program should be controlled and gradually increase over time. manual manipulation from osteopathic doctors, physiatrists or other appropriately trained health professionals, can help reduce pain by mobilizing painful joint dysfunction

4) Epidural steroid Injections If the patient is having severe pain, injections can be useful. Epidural injections can help decrease inflammation in the area. The pars fracture itself can be injected with lidocaine and steroids for a diagnostic study. If the patient’s pain is relieved after a lidocaineinjection it can be assumed that the pars fracture is the source of the patient’s pain. The steroid can be useful to reduce inflammation in the pars interarticularis, helping to relieve the pain and allow the patient to progress with physical therapy and non-surgical treatment.

5) Spondylolisthesis Surgery In most cases non-surgical treatment is successful in relieving the patient’s pain, but if not surgery may be considered.
Spinal fusion surgery for spondylolisthesis is generally quite effective, but because it is a large procedure with a lot of recovery, it usually is not considered until a patient has failed to find pain relief with at least six months focused on a range of non-surgical treatments.
A posterior fusion with pedicle screw instrumentation is generally considered the gold standard form of lumbar spinal fusion. The surgeon may also recommend a spinal fusion done from the front of the spine at the same time. The type of spinal fusion that is recommended by a surgeon is based largely on a surgeon’s preference and experience, as well as the patient’s clinical situation.