Spondylolisthesis Treated by Mercy’s Top Spine Doctors

Degenerative Spondylolisthesis

Spondylolisthesis means slippage of the spine. Discs in the spine tend to lose some of their water content and become dehydrated as they age. As this occurs, the disc height decreases resulting in mild loss of overall patient height. The narrowed disc bulges on the sides much like a partially flat tire. The aging disc is less firm, allowing some shifting of the neighboring vertebra (degenerative spondylolisthesis).

The forward/backward shifting of the vertebra often irritates the spinal nerves and causes bone spurs and enlarged spinal ligaments. The combination of vertebral shifting, disc bulging, bone spurs and enlarged ligaments also can lead to a narrowed spinal canal or spinal stenosis.

Stress Fracture Spondylolisthesis

Spondylolisthesis can also be caused by a stress fracture in the lower back that occurred in childhood but never completely healed. In most cases, this bone defect does not cause ongoing symptoms and is often unrecognized until later in life. The fracture produces weakness within the spinal column and in some cases leads to premature disc degeneration at the base of the spine. As the disc wears out, the fractured vertebra shifts forward out of alignment.

Typically, the slip occurs between the lowest lumbar vertebra (L5) and the sacrum, but can occur at other levels within the spine. The disc degeneration and associated arthritic changes often cause nerve compression and irritation.

Symptoms of degenerative spondylolisthesis include:

• Back pain with discomfort or burning into the buttocks, thighs, legs and feet
• Numbness
• Weakness
• Forward hunched posture
• Difficulty walking more than short distances

Spine specialists diagnose spondylolisthesis with the assistance of X-rays as well as CT scans or MRIs to understand whether or not any of the discs have shifted.

Adolescents or adults who had a stress fracture as a child may experience of the following spondylolisthesis symptoms:

• Buttock and leg pain
• Hamstring tightness
• Physical deformity
• Abnormal bowel and bladder function

In the worst cases, the lumbar spine dislocates over the front of the sacrum, a condition known as spondyloptosis (spine dislocation), causing patients to lose height between their rib cage and pelvis until their ribs rest upon their pelvis. Their rib cage projects in front of their pelvis, their buttocks are flattened, and they walk with a crouched posture.

The body is able in most cases to maintain stability to the spinal column and prevent the vertebra from actively shifting back and forth on each other through the accumulation of bone spurs. If this is the case, then spondylolisthesis symptoms are best treated with:

• Medications
• Intermittent bracing
• Epidural steroid injection
• Decompression surgery

Patients with persistent low back pain, nerve irritation and/or progression of the slip, require surgery in order to provide a more lasting relief and return to normal activities. When symptoms persist in children and young adults with stress fractures without vertebra shifting, a fracture repair procedure alone is often possible. For more severe cases with nerve compression and spondylolisthesis, decompression surgery and minimally invasive fusion surgery provides relief of the nerve compression and stabilization of the shifted vertebrae.

Our doctors have developed advanced surgical methods based upon stress relaxation to restore normal spinal alignment, trunk height and body proportions. The preferred method of surgery is performed through one midline back incision. Anterior surgery (across the abdomen) is not required. Both fusion rates and spine biomechanics are enhanced by restoring the normal alignment of the spine. Clinical research with long-term follow-up has documented long-term clinical success with these procedures.