Spondylolisthesis

Sometimes a vertebra can develop a defect, like a crack, on both sides of the bony ring of the spinal column. When that happens, the bone is weakened and cannot maintain its proper position. The defective vertebra can slip forward relative to the vertebra below it and cause a condition called Spondylolisthesis.

Spondylolisthesis is a condition in which one vertebra slips forward over the one below it. Spondylolisthesis is a fairly common cause of lower back pain and leg pain in younger adults (age 30 to 50), and degenerative spondylolisthesis is a fairly common cause of pain in older adults (age 50 and up). The most common symptoms are lower back pain and/or leg pain that limits activity level.

Degenerative Spondylolisthesis symptoms

As the facet joints in the spine degenerate they often get larger, which can encroach upon the spinal canal that runs down the middle of the spinal column, resulting in spinal stenosis. The symptoms of a degenerative spondylolisthesis are very commonly the same as that of spinal stenosis.

The main symptoms of degenerative spondylolisthesis include:

  • Lower back pain and/or leg pain are the most typical symptoms of degenerative spondylolisthesis. Some patients do not have any back pain with degenerative spondylolisthesis and others have primarily back pain and no leg pain.
  • Patients often complain of sciatic pain, an aching in one or both legs, or a tired feeling down the legs when they stand for a prolonged period of time or try to walk any distance (called pseudoclaudication).
  • Generally, patients do not have a lot of pain while sitting, because in the sitting position the spinal canal is more open. In the upright position, the spinal canal gets smaller, accentuating the stenosis and pinching the nerve roots in the canal.
  • Patients typically have tight hamstring muscles (the muscles in the back of the thigh) decreased flexibility in the lower back, and difficulty or pain with extension (arching the back backwards).
  • The nerve root pinching can lead to weakness in the legs, but true nerve root damage is rare.

surgical treatment options

Surgery for a degenerative spondylolisthesis usually includes two parts, done together in one operation:

  • A decompression (also called a laminectomy)
  • A spine fusion with pedicle screw instrumentation

Decompression surgery (e.g. a laminectomy) alone is usually not advisable as the instability is still present and a subsequent fusion will be needed in up to 60% of patients. A 1991 randomized controlled study of fusion with and without pedicle screw instrumentation and found the fusion rates were much higher in the patients with instrumentation, but the clinical results were about the same1. However, when these same patients were followed up on 10 years later, the patients with a solid fusion ultimately fared significantly better than those that had not fused.

t is a difficult surgery to recover from as there is a lot of dissection. The hospital stay typically ranges from one to four days. It can take up to a year to fully recover. Usually, most patients can start most of their activities after the fusion has had three months to heal. Once the bone is fused, then the more active the patient is the stronger the bone will become.

Potential Benefits of the Surgery

Spinal fusion surgery for a degenerative spondylolisthesis is generally quite successful, with upwards of 90% of patients improving their function and enjoying a substantial decrease in their pain.

Potential Risks and Complications

There are numerous risks and possible complications with surgery for degenerative spondylolisthesis and they are basically the same as for any fusion surgery. There are risks of non union (non-fusion, or arthrodesis), hardware failure, continued pain, adjacent segment degeneration, infection, bleeding, dural leak, nerve root damage and all the possible general anesthetic risks (e.g. blood clots, pulmonary emboli, pneumonia, heart attack or stroke). Most of these complications are rare, but increased risks can be seen in certain situations. Conditions that increase the risk of surgery include smoking (or any nicotine intake), obesity, multilevel fusions, osteoporosis (thinning of the bones), diabetes, rheumatoid arthritis, or prior failed back surgery.

If you'd like to discuss this condition with one of our doctors, we would be more than happy to contact you.  You don't need a primary care physician referral for us to see you. 

 

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