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Spondylolisthesis

Spondylolithesis is the slipping of one of your spine vertebrae in relation to the bone below it.

Common Signs & Symptoms

  • Generalised low back pain, worse with activities involving arching backwards, prolonged standing, during long walks or when bending or twisting
  • May have a history of sports which involve arching backwards eg fast bowling/ gymnastics
  • Pain, numbness, tingling or weakness of one or both legs
  • Loss of bladder or bowel control, in rare cases
  • X Rays provide confirmation

Description

Spondylolithesis is the slipping of one of your spine vertebrae in relation to the bone below it. It usually occurs when there is a defect or stress fracture (Spondylolysis - Pars Stress Fracture) in the bony bridge (called the pars interarticularis of the vertebral arch) on both sides of your vertebrae. It’s most common in the lower back and is thought to be caused by a birth defect or sudden trauma in the young, or from degeneration in the elderly. Some sports such as gymnastics, weightlifting and fast bowlers in cricket carry an increased risk of spondylolisthesis usually as a result of sudden back flicks into extension (or arching).
Spondylolisthesis symptoms can vary from none at all to severe, shooting pains in the back and/or legs. Nerve damage may also occur if there is pressure on the nerve roots as they leave the spine.

Over time, degenerative changes of spondylolysis can cause serious complications including:

Spinal & Foraminal Stenosis
Cauda Equina Syndrome
Radicular Pain

Advice & Treatment

Diagnosis of spondylolisthesis can be confirmed by plain x-ray. Treatment for spondylolisthesis depends on the severity of your condition.

The initial goal of treatment is to settle your pain and reduce the stresses going through your back:

Managing your pain

  • Anti-inflammatory painkillers or stronger painkillers available on prescription - see your pharmacist or doctor, especially if you are taking other medication
  • Short periods of bed rest (no longer than 48 hours) while you are experiencing symptoms, avoid sports involving contact or arching backwards and try not to over-stretch your spine
  • Relieve muscle spasm – medication, warm baths/heat and massage

Improving your control

  • Improve the mobility of your joints above and below the fracture (hip joints, middle back joints) using stretches or physiotherapy
  • Strengthen your core abdominal muscles – this will help them to stabelise your lower back and pelvis and reduce the movement at the area of your fracture, so exercises such as Pilates are ideal

You may find symptoms go away with time but if not, steroid and anaesthetic injections around the compressed nerve and into the spinal canal can provide temporary relief. Should you experience compression of your nerves, surgery may be considered to fuse and stabilise the slipped vertebrae.

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