Topic Overview
What is spondylolisthesis?
Spondylolisthesis is a condition in which one bone in your back
(vertebra) slides forward over the bone below it. It
most often occurs in the lower spine (lumbosacral 
area). In some cases, this
may lead to your spinal cord or nerve roots being squeezed. This can cause back
pain and numbness or weakness in your legs. In rare cases, it can also lead to
losing control over your bladder or bowels. See a doctor right away if you
begin losing bladder or bowel control.
Sometimes when a vertebra slips out of place, you may have no
symptoms at all or no symptoms until years later. Then, you may have pain in
your low back or buttocks. Muscles in your leg may feel tight or weak. You may
even limp.
What causes spondylolisthesis?
The bones in your spine come together at several small joints
that keep the bones lined up while still allowing them to move.
Spondylolisthesis is caused by a problem with one or more of these small joints
that allows one bone to move out of line.
Spondylolisthesis may be caused by any of a number of problems
with the small joints in your back. You could have:
- A defective joint that you've had since birth
(congenital).
- A joint damaged by an accident or other
trauma.
- A vertebra with a
stress fracture caused from overuse of the
joint.
- A joint damaged by an infection or arthritis.
Spondylolisthesis affects children and teens involved in sports.
Some sports, such as gymnastics or weight lifting, can overuse back bones to
the point of causing stress fractures in vertebrae, which can result in
spondylolisthesis.
Older adults can develop spondylolisthesis, because wear and tear
on the back leads to stress fractures. It can also occur without stress
fractures when the disc and joints are worn down and slip out of place.
What are the symptoms?
Symptoms of spondylolisthesis may include:
- Back or buttock pain.
- Pain that
runs from the lower back down one or both legs.
- Numbness or
weakness in one or both legs.
- Difficulty walking.
- Loss
of bladder or bowel control.
- Leg, back, or buttock pain that gets
worse when you bend over or twist.
Sometimes spondylolisthesis causes no symptoms at all.
How is spondylolisthesis diagnosed?
Your doctor will look at X-rays of your back if he or she
suspects you have spondylolisthesis. X-rays will show if any of the vertebrae
in your back have fractures or cracks and have slipped out of place. You could
also have a
CT scan or an
MRI to pinpoint the damage and help guide
treatment.
How is it treated?
Treatment for spondylolisthesis begins with stopping any physical
activity that may have led to vertebrae damage. To help relieve pain, take
nonsteroidal anti-inflammatory drugs, including
aspirin (such as Bayer), ibuprofen (such as Advil), or naproxen sodium (such as
Aleve). Do not give aspirin to anyone younger than 20because of the risk of
Reye's syndrome, a serious illness. Acetaminophen
(such as Tylenol) can also help with pain.
Doctors often suggest
physical therapy to build up stomach and back muscles
(core strengthening). In overweight people, weight loss
may also help. When pain is extreme or bones continue to move, or if there is
nerve root or spinal cord damage related to the spondylolisthesis, surgery can
sometimes help. Surgery may be done to remove bone or other tissue to take
pressure off the spinal cord or nerves (decompression). Or surgery may be done
to fuse the bones in position. Sometimes both decompression and fusion are done
during the same surgery.1 A newer surgery that uses a
man-made
ligament to make the spine more stable is also being
done for mild to moderate spondylolisthesis.2 After
any of these surgeries, you may need to wear a cast or back brace for a while.
Later, rehabilitation therapy will help make your muscles stronger and movement
easier.
