Spondylolisthesis

Spondylolisthesis is a spinal condition that affects the lower vertebrae of the spinal column. This disease causes one of the lower vertebrae to slip forward onto the bone present beneath it. It’s a painful condition but treatable in most cases, both by therapeutic as well as surgical methods.

The symptoms of spondylolisthesis vary. People suffering from mild symptoms may not have any symptoms, but those with severe cases may be unable to perform daily activities. Few most common symptoms are:

• Persistent pain in the lower back.
• Stiffness in the back and legs.
• Tenderness in the lower back.
• Pain in the thigh.
• Tightness in hamstring and buttock muscles
• Difficulty walking.

Spondylolisthesis has many causes, some of them are:

• Above 50 yrs of age, 
• Heredity.
• Birth defect
• Sudden injury or trauma to the spine.
• Repetitive trauma to the spine.
• Rapid growth during adolescence.
• Strain or overstretch and stress on the lower back.
• Sports such as football, weightlifting, gymnastics, track, and field.
• Spondylolysis. 

Pathology:

Pathology of spondylolisthesis involves a fractured pars interarticularis of the lumbar vertebrae, also called the isthmus. This affects the supporting integrity of the vertebrae, which could lead to slippage of the corpus of the vertebrae, called spondylolisthesis. This, in turn, leads to lumbar instability. This slippage can occur in 2 directions: anterior translation, called anterolisthesis, or backward translation, called retrolisthesis. Ligamentous structures, including the iliolumbar ligament, between L5 and the sacrum, are stronger than those between L4 and L5, because of which the vertebral slip commonly develops in L4.

Physical examination:

Physical examination is the first step in diagnosing this condition. In the case of spondylolisthesis, the patient may have difficulty raising the leg straight outward during simple exercises. 

X-rays:

X-rays of the lower spine are used to determine whether a vertebra is out of place. The examiner may also look for any possible bone fractures on the X-ray images.

CT-scan:

CT scan shows a more detailed image of the misplaced bone pressing on the nerves.

Magnetic resonance imaging (MRI):

Magnetic resonance imaging (MRI) scans help locate pinched nerves.

Medication: Anti-inflammatory drugs such as ibuprofen, epidural steroid injections, etc.

Note: Medication should not be taken without the doctor’s prescription.

Surgery:

The treatment for spondylolisthesis depends on the severity of pain and vertebra slippage Adults suffering from severe cases of spondylolisthesis may need to have spinal fusion surgery. Surgical correction of the misplaced vertebra is required when the bone has slipped so far down that the spine doesn’t respond to nonsurgical therapies. Surgery is also required if the bones of the spine are pressing on the nerves.

Thermotherapy:

Thermotherapy provides relief by increasing circulation and decreasing pain.

Cryotherapy:

Cryotherapy is used to provide relief for sore muscles.

Ultrasound therapy:

Ultrasound therapy works by passing the sound waves causing tissues to oscillate at a frequency that increases blood flow. 

Transcutaneous electrical stimulations (TENS):

This electrical modality stimulates the muscles through variable intensities of electrical current. TENS helps reduce muscle spasms and increases the body’s production of endorphins (natural painkillers).

Interferential therapy (IFT):

IFT helps to increase blood circulation, stimulates the spinal nerve, and reduces pain and inflammation.

Brace:

A brace can be used temporarily used for relief. Though, wearing a brace for a long time can make the muscles weaker.

Massage therapy:

Massage uses the application of appropriate pressure, to reduce pain, increase blood flow, reduce swelling, promote tissue growth, and provide relief from muscle spasms.

Manual therapy:

Manual therapy reduces pain, and thus improves function by increasing the range of motion, e.g., manipulation, mobilization, etc.

Exercises:

Exercises include a simple range of motion like flexion, extension, side flexion, and rotation movements. Stretching exercises are done to decrease stiffness and pain. And also increase the flexibility of the lumbar spine. Strengthening exercises are recommended to regain the lost strength of the back muscles. These exercises include isometric exercises, isotonic exercises, and many more.

The patient is advised to maintain the alignment of the spine during sitting and standing activities, not to remain in the same position for a longer period, and therefore take breaks in between. Medical intervention is crucial for relieving symptoms of spondylolisthesis. Early treatment measures are advised to alleviate most symptoms of this condition, as it can cause pain and permanent damage if left untreated.