Spondylolisthesis -Degnerative

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Spondylolisthesis occurs when one vertebra slips forward over the vertebra below. Degenerative spondylolisthesis often affects the lumbar (low back) spine, often at L4-L5 (4^th and 5^th lumbar vertebral levels). Degenerative changes in vertebral structure may cause joints between vertebrae to slip forward creating a spondylolisthesis.  Sometimes spinal stenosis develops with spondylolisthesis. Degenerative spondylolisthesis is more common in older female patients over age 60.

Symptoms

Some people with spondylolisthesis are symptom-free.  Spondylolisthesis may be discovered when the patient has a lumbar x-ray for back pain or another problem.  Symptoms may include:

• Low back pain
• Sciatica
• Muscle spasms
• Leg weakness
• Tight hamstring muscles
• Irregular gait or a limp

Video:Spondylolisthesis
Click below to view a video from our library about this condition.

An accurate diagnosis of spondylolisthesis can be made by a physician with expertise in spinal disorders. This may include the following steps.

Medical history
The doctor asks you about your symptoms, severity, treatments tried, and the results.

Physical examination
The physician examines you for movement limitations, balance problems, and pain. He tests your reflexes, evaluates muscle weakness, sensation, and signs of neurological injury.

Diagnostic tests
Spondylolisthesis is detected on a lateral (side) lumbar x-ray. If necessary, a CT scan or MRI may be ordered obtain information about your anatomy in greater detail.

Classifaction of Spondylolisthesis

Information from your imaging studies is used to grade the degree of vertebral slippage from mild to severe.  Doctors use the Meyerding Grading System to classify the degree of vertebral slippage.  This system is easy to understand. Slips are graded on the basis of the percentage that one vertebral body has slipped forward over the vertebral body below.

• Grade I:  1-24%
• Grade II: 25-49%  
• Grade III: 50-74%
• Grade IV: 75
• %-99% slip.
• Grade V: Complete slip (100%), known as spondyloptosis

Treatment is based on the degree of slip and factors, such as intractable pain and neurological symptoms. Most instances of degenerative spondylolisthesis are Grade I or II.  In general, the more severe the slip (Grades III and above), the more likely surgical intervention will be required.

Non-operative Treatment

Often degenerative spondylolisthesis is treated without surgery.  

Treatments include:

• Short-term bed rest
• Activity restriction
• Over-the-counter or prescription pain medication
• Anti-inflammatory medication
• Muscle relaxants
• Steroid injections (i.e., lumbar epidural steroid injection)
• Physical therapy
• Bracing

Degenerative spondylolisthesis can be progressive.  This means the spondylolisthesis worsens over time.  Follow up with your doctor to monitor reatment progress and spondylolisthesis is important for recovery.

Surgery

If your degenerative spondylolisthesis progresses or causes neurologic problems, such as incontinence, surgery may be recommended.  Spinal instrumentation (i.e., rods, screws) and fusion (bone graft) are common procedures to stop slip progression and stabilize the spine. There are different types of instrumentation, bone graft and graft products, as well as procedures (some minimally invasive) to surgically treat degenerative spondylolisthesis. Your surgeon will discuss the types of surgery and risks and benefits.

Conclusion

Higher grades of degenerative spondylolisthesis can be serious. However, many safe and effective treatment options are available. Many patients resond well to non-surgical therapies.

To download our Patient Guide to spondylolisthesis, click here.