Spondylolisthesis is a lumbar spine (low back) disorder.  It occurs when one vertebra slips forward over the vertebra beneath.  There are two types of spondylolisthesis:

Degenerative spondylolisthesis is most common in women over age 60.  It is caused by degenerative (eg, age-related) changes in vertebral structures that allow a vertebral body to slip forward.  Degenerative spondylolisthesis may cause lumbar spinal stenosis.

Isthmic spondylolisthesis is caused by a defect or fracture of the pars interarticularis; a bone that connects the upper and lower spinal joints (facet joints).  Sometimes accumulated spinal stress causes this type of fracture.  This is usually the type of spondylolisthesis that affects young athletes.

Symptoms
Not all people with a spondylolisthesis know they have the disorder.  Many are symptom-free.  Sometimes it is discovered when they undergo x-ray or other spinal imaging test to diagnose a different problem.  Spondylolisthesis symptoms may include:

• Low back pain
• Sciatica
• Muscle spasms
• Leg weakness
• Tight hamstring muscles
• Irregular gait or limp

Talk with your doctor
Sudden pain or pain that is severe, or that becomes chronic or progressive, requires evaluation by your doctor.  Perhaps your doctor has already diagnosed you with a spondylolisthesis.  If that is the case, he will want to know about any new symptoms, especially weakness, balance or walking difficulties, or bladder or bowel dysfunction.

Diagnosis
Your doctor collects and compares information gathered while talking with you about your medical history and past and existing symptoms.  A physical and neurological examination looks for limitations of movement, balance difficulties, and what exacerbates and relieves pain.  During the exam he tests your reflexes, muscle strength, sensations, or other signs of neurologic loss.  Your doctor may order imaging studies such as plain x-ray, CT, or MRI to study and confirm you diagnosis to direct your treatment plan.

Spondylolisthesis grading
There are five Grades of spondylolisthesis.  Grade I is a small slip and Grade V is a complete slip.  From your imaging studies (eg, x-ray) your doctor can Grade your spondylolisthesis.

• Grade I:  1-24%
• Grade II: 25-49%  
• Grade III: 50-74%
• Grade IV: 75%-99% slip.
• Grade V: Complete slip (100%), known as spondyloptosis

The grade of your slip and symptoms help your doctor to recommend the best treatment options for your spondylolisthesis.  In general, more severe slips, such as Grade III and greater, may require surgical treatment.

Treatment
Non-surgical treatment may include:

• Best rest for a short time
• Activity restriction
• Over-the-counter or prescription pain medication
• Non-steroid anti-inflammatory drugs (NSAIDs)
• Muscle relaxants
• Steroid injections
• Physical therapy
• Bracing

Once again, depending on the severity (grade) of your spondylolisthesis, if it is or may become progressive, and existence or extent of related neurological symptoms, surgery may be recommended.  The goals of surgery may involve restoring spinal stability and relieving pain.

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