Definition Spondylolisthesis means the slipping of one vertebra over the top of the one below it. The vertebrae are the box-shaped bones that make up the spine.
What is going on in the body? Normally, the vertebrae are stacked up and aligned with each other. Under certain circumstances, one vertebra may slip forward over the one below. This usually occurs in the lower back area, though the neck can also be affected.
What are the signs and symptoms of the condition? A person with this condition often has no symptoms. Those with symptoms may complain of:
a non-specific backache or back pain, usually in the lower back. Pain is usually worst when upright, playing sports, and/or bearing weight. The back pain may spread into the buttock or thighs.
loss of bladder and bowel control, in very severe cases
The doctor can test for signs of:
a lack of flexibility in the lower back. This may cause difficulty in bending over to touch the toes.
hamstring tightness, with a limited ability to raise the legs from off the ground while lying flat on the back
arching of the lower back
sensitivity in the area when touched
a "step-off" in the spine that can be felt at the level of the slip
What are the causes and risks of the condition? Inborn defects, injury, or diseases may cause this condition. In adolescents, the most common cause is spondylolysis. In this condition, the bony arch of the vertebra of the low back is abnormally soft and able to slip easily. In the elderly, the most common cause is osteoarthritis, the common form of arthritis, in the spine. In this condition, the joints between the vertebrae become worn and unstable.
The risk of getting symptoms may be increased by sports, such as gymnastics, football, and weight lifting, and by heavy labour.
What can be done to prevent the condition? Sports safety guidelines should be followed for adults, adolescents, and children.
How is the condition diagnosed? Because there are often no signs or symptoms, this condition is usually noticed by accident on plain or other special x-ray tests of the lower back.
What are the long-term effects of the condition? In minimal and stable cases, there may be susceptibility to back pain with heavy lifting or back trauma during sports and other activities. In more severe cases, the person may experience greater slipping of the spine and lower back discomfort. Problems with the nerves in the lower extremities may possibly develop.
What are the risks to others? There are no risks to others.
What are the treatments for the condition? Treatment depends on the age of the person, the degree of slip, and the cause. Mild cases can be treated with reduced activity, flexibility and strengthening exercises, and possibly a back brace. An operation to fuse the affected vertebrae, called spinal fusion, is considered in serious cases. For example, when the slip is great and there are symptoms of nerve involvement, surgery is often advised.
What are the side effects of the treatments? Possible complications from surgery include infection, failure to correct the slip, failure of the bone to fuse, or nerve damage.
What happens after treatment for the condition? Progressive slipping of the vertebrae can occur despite appropriate treatment.
How is the condition monitored? Affected people should watch for symptoms and signs, including poor posture with arching of the lower back. X-ray tests may be taken every 6 months during adolescence when the body is growing rapidly.
Author: John A.K. Davies, MD Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 16/10/2004 Contributors Potential conflict of interest information for reviewers available on request
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