Spondylolysis and spondylolisthesis are oftentimes mistaken for one another. However, this condition is characterised by a forward slipping (anterior displacement) of one or more vertebrae that invariably results in stenosis of the spinal canal, meaning that a vertebral body or vertebra slips forward.
Slippage can occur if the adjacent ligatures are weak, which is often the case in the lumbar spine area, particularly in people who live a sedentary lifestyle, leading to a type of spondylolisthesis called lumbar spondylolisthesis. Other types include isthmic spondylolisthesis and degenerative spondylolisthesis.
There are five main causes of displacement:
2.a. Stress fracture & 2.b. Acute fracture
3. Elongated intact pars interarticularis
4. Degeneration or trauma which can apply to different parts of the vertebrae
5. Pathological (tumour/vascular disorders etc).
There are also four levels of displacement possible:
Level 1 (25% slippage which is not regarded as serious and where mild symptoms are not too troublesome - patients do not like to stand or sit upright for long and are adverse to lifting objects).
Level 2 (50% slippage which causes a lot of pain and stiffness as the dura is tightened, and which is commonly associated with a herniated disc.)
Level 3 (75%)
Level 4 Complete displacement which is very dangerous as this could cause paralysis through the total obstruction of the spinal canal.
X-rays should be carried out when the patient is standing to correctly ascertain the extent of displacement, and any physical examination is carried out in the same way.
Palpation always shows a small indentation in the patient's back at the point of displacement, which can even be visible in the surface tone of the skin, depending on the level of severity.
When the patient lies down with knees bent at 90 degrees, the indentation is no longer palpable because in the lying position the spine is naturally decompressed by 25% and the vertebrae can re-align of their own accord.
Although mobilisation can be carried out for all levels of displacement, manipulation is always contra-indicative for this condition and must never be conducted.
Any level of displacement up to level 4 can be successfully treated non-surgically, although surgery may have to be considered if the patient is obese (as the spine is under more pressure), and may also be necessary if the condition is found to be progressive over a three - six month period.
Depending on the patient, anything from grade 2 may require surgical treatments or interventions such as spinal fusion to stabilise the joint. In all cases where nonsurgical treatment is possible, the condition is treated symptomatically depending on the spinal areas affected, keeping in mind that the lower or supporting vertebra is always stiffer as a result of the displacement.
In conjunction with treatment for spondylolisthesis, a specific set of exercises are given to build up the muscles of the trunk. The patient is, however, never allowed to raise their legs because this action causes the spine to become elongated. Strengthening exercises are a mixture of isotonic (repetitious) and isometrical (maintaining tension).
Swimming is beneficial, but not contact sports or horse riding, and running on a soft surface is also feasible for an otherwise healthy patient experiencing only minor displacement.
The largest joints in the spine are L4 and L5 and as these sustain the most pressure, they are affected in 65% of all cases. Between 30%-60% of cases are linked to accidental trauma of some kind.
It can safely be said that for the vast majority of spinal conditions surgery is neither necessary nor effective, as it almost always leads to long term complications and suffering for the patient, out of all proportion to the original condition.
The use of metal rods, screws and plates and the cutting away of parts of the spine, even the heating of discs to cause them to shrink (IDET procedure) represent a rather crude approach to the treatment of spinal problems and is not a method of 'treatment' that we can ever recommend.
The procedures of Orthopaedic Medicine outlined above do not involve operating on a patient, and all treatment is safe and manageable as well as being highly effective.