Spondylolisthesis – A Fancy Name for a Common Spine Problem
In adolescents back pain may begin as the bones shift and become irritated because of their abnormal connection in the spine. As children become more active in sports and use their backs for athletic activities, the instability related to the lack of connection in the back bones will start to become painful. X-rays, taken at this time, may show a break in the bones; however, there are a significant number of these kids with back pain who will have normal looking x-rays. These children may need to have a further evaluation with a CT scan to help visualize the bones of the spine more specifically. There a large portion of these individuals that may live their entire lives with a break in their vertebrae and not experience back pain until their discs start to degenerate.
The largest group of patients with spondylolisthesis have degeneration in the discs that leads to back pain and doctor visits is the middle age population. As the discs degenerate, they are not able to support the weight of the spine, which allows the bones to shift. Because the position of the bones changes, the discs will have to bear the brunt of the patient's body weight and movement, which applies more stress to the discs and forces them to degenerate faster.
Most patients with a mild slippage of the bones will not have any worse back or leg pain than most people their age. There are no particular restrictions in activities that need to be considered in mild spondylolisthesis. As patients age the discs that are between the slipped bones will continue to degenerate. Not only is disc cartilage degeneration painful, but it can also lead to an increase in the slippage of bones. As the spine continues to degenerate and slip, the nerves that are protected by the bones will begin to receive pressure from the discs and bones. Pinching the nerves in the back will cause pain in the distribution of the nerve roots. This pain is felt in the back of the legs and down to the foot, called sciatica. Nerve pain is usually the most painful, and patients will be curious as to why the doctor is checking the back when it is the leg that hurts so bad.
The initial treatement for the pain associated with spondylolisthesis is physcial therapy combined with anti-inflammatory medications. Traction, manual therapy, and even stretching and exercise can be helpful in relieving pain. The goal is to try to relieve the pressure on the nerve and mobilize the bones and discs to allow for a more fluid motion of the back without irritating the muscle, tendon or nerves. Most patients respond favorably to this treatment and can maintain their spines with exercise at home. If this treatment is not successful, injections of steroids around the nerves and joints may be helpful in relieving some of the acute pains. After pain reduction, the exercise program may be more effective. If all of these treatments don’t work, surgery should be considered to relieve the back and leg pain. Although, most patients are reluctant to have back surgery, with the improved techniques used by the fellowship-trained orthopaedic spine surgeon, spondylolisthesis is one of the conditions of the spine that responds very successfully to surgery.
