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Spondylolisthesis is a condition in which a vertebra (Greek=spondylos) shifts from its normal position (Greek=listhesis). Most cases of Spondylolisthesis are Anterolistheses (forward slippages).
The shift from its normal position most commonly happens due to defect (or less commonly an elongation) in the pars interarticularis or isthmuswhich is a section of bone that joins the front of the vertebra to the arch in the rear. This type of spondylolisthesis is called “isthmic” and is found in about 10% of the population. Male to female incidence is roughly 2:1, though slippage tends to be worse in females. There is evidence to suggest a familial tendency. There still remains some debate as to whether the gap is an actual fracture (most likely in childhood, possibly through constant falls on the bottom), or whether it is a failure of that section of bone to fuse together properly as the child grows. The pars interarticularis has been identified as being subject to more mechanical stress than any other structure in the lumbar spine, so the development of stress fractures are a plausible theory. They have been found in children, adolescents and adults. To date, humans are the only species in which the condition has been identified.
Spondylolistheses (plural) are graded according to how far forward they have “slipped” on an X-ray analysis. The L5 disc (lowest disc in the spine) accounts for 90% of cases. About 80% of these cases are a grade 1 (i.e. shifted forward up to 25%). Grade 2 (shift forward up to 50%), 3 (shift forward up to 75%) and 4 (shift forward 75% up to dislocation, which is then called a spondyloptosis) are much rarer. In the X-ray to the right, you can see a grade 1 spondylolisthesis of L4 on L5, as well as a grade 1 spondylolisthesis of L5 on the Sacrum Spondylolistheses (the majority being grade 1) are quite stable, and generally do not progressively slide further forward with age, however some progression has been seen in adolescents, and is thought to perhaps be hormonally related.
Symptomatically, people with a spondylolisthesis do have greater loads placed across their discs and so degenerative disc changes can be accelerated, leading to a deeper curve in the low back, with chronic stiffness and aching fairly common. Care must be exercised when lifting heavy loads, or maintaining strained postures for long periods of time as fatigue of ligaments and muscles happens easier than the average. In some cases, the forward shifted vertebra can cause pressure on the spinal membranes, nerve roots and cord, which can give a range of possible symptoms from sciatica to claudication (pain or weakness after walking short distances) or worse.
Quite often a Spondylolisthesis is an incidental finding on an X-ray, though most of the time a deepening of the curve of the low back (called a lordosis), along with a step defect felt by feeling the back of the patient will predispose the treating practitioner to refer for an X-ray in the first place. A history of chronic dull back pain, which is exacerbated by lifting or prolonged strain can be a clue to the condition.
Treatment usually centres on strengthening the spinal support muscles (which includes the abdominal, spinal, hip and buttock muscles among others); as well as improving flexion (see our exercise section Low Back Pain Flexion Exercises ). Chiropractic care can be of great assistance in cases of spondylolisthesis, with much of the treatment addressing the need to decompress and draw back the vertebra that has positioned itself forward. Several different types of adjustments are commonly used, with manipulative techniques, drop piece tables, flexion-distraction disc pumping, SOT blocking among the favoured techniques within Chiropractic. While much relief can be had with these techniques, the central issue remains the defect at the pars interarticularis, so these patients often benefit from periodic maintenance care, along with their own self-care routines. In combination with acupuncture, massage, heat and stretching, most cases of back pain relating to sciatica can be effectively managed with chiropractic care.
In the very rare cases where severe slippage has occurred and conservative strategies have failed, surgery may be the only option. This involves fusion or clamping the slipped vertebra with metal screws is only indicated in severe cases (usually grade 3 or 4), though a severe grade 2 with leg weakness, numbness and loss of reflexes might also qualify. If you suffer from symptoms associated with spondylolisthesis, why not call the clinic on 9822 0588 and make an appointment for a Chiropractic assessment. Many patients who suffer chronic back pain due to a “spondy” find regular Chiropractic care to be invaluable in helping them stay pain free and feeling their best.