Spondylosis & Spondylolisthesis

What is Spondylosis?

Spondylosis is a broad term referring to wear and tear of the spine. As part of the normal aging process, intervertebral discs dry out and shrink. In advanced cases, the disc dries out completely, and the vertebrae rub against one another, causing arthritis and bone spurs. Many providers use the words "spondylosis" and "spinal osteoarthritis" to mean the same thing.

What is Spondylolisthesis?

Spondylolisthesis refers to a misalignment of one vertebra on top of another. (For simplicity, it is commonly referred to as a "spondy.") It most commonly occurs in the lumbar spine. It is a common cause of back pain. There are several causes of spondylolisthesis, but the most common are "isthmic spondylolisthesis" and "degenerative spondylolisthesis." The most common spinal levels where either of these occurs is in the lower lumber spine (L4/5 or L5/S1). Spondylolisthesis may also occur in the cervical spine, but it is less common.

Causes

  • Isthmic Spondylolisthesis: This form of spondylolisthesis most commonly develops in children. In about 5% of children, a defect or fracture in the vertebra (the "pars articularis," also known as a "pars fracture" or "spondylolysis") develops. This is more common in gymnasts, weightlifters, and any sport that involves excessive extension of the back. The defective vertebra is no longer stable, and the top vertebra will shift forward.

  • Degenerative Spondylolisthesis: As the spine ages, joints that keep the spine stable may wear out. As this happens, one or more vertebrae may move forward ("anterolisthesis") or backward ("retrolisthesis"), resulting in pain and sometimes in nerve compression and damage. In patients with previous spine surgery, this process may be more common, especially if the vertebrae have been damaged or made unstable by an inexperienced surgeon.

 

Symptoms

A spondylolisthesis represents a point of instability in the spine. Most of the symptoms are related to the instability or shifting of the spine in different positions. Many patients will have a spondylolisthesis and not know it. For many others, there is aching low back pain that is worse in certain positions. Often, patients will notice that getting up from a seated or lying position causes severe pain. The abnormal movement in the spine may cause pinching of spinal nerves, leading to aching or pain in the legs.

Diagnosis

Spondylolisthesis ​is usually first diagnosed by x-ray. It is often helpful to perform x-rays leaning forward and backward to assess how unstable the spine may be.

The most important part of the diagnosis is a proper evaluation by a specialist.

  • History: Your medical provider should appreciate that your medical history may affect the type of spondylolisthesis that develops. Your provider will also learn all previous treatments you have had, and if they have provided any relief. It is important to provide a detailed list of all spinal surgeries you have had, as they may have contributed to spondylolisthesis.

  • Physical Examination: In addition to a good medical history, a thorough physical examination is the most important part of the diagnosis for any spine-related problem. During the physical examination, your provider will assess what movements worsen our back and/or leg pain.

  • X-rays: X-rays provide necessary information for spondylolisthesis. Even if other images have been taken, x-rays provide unique information that is not available from other studies.

  • MRI: An MRI scanner uses a magnetic field and radio waves that are not harmful to visualize the body in 3D. In most circumstances, it is the best way to see the soft tissues of the body, including nerves, intervertebral discs, and other parts of the spine other than the bones. An MRI is not necessary to diagnose spondylolistnesis. However, it may be helpful to determine what nerves may be affected by the instability of the spine.

  • CT: A CT scan uses many x-rays to produce a 3D image of the body. It is often the best way to visualize the spinal bones or bone spurs. It may be used to show a fracture ("pars fracture") that caused a spondylolisthesis.

Treatment

For many patients, Nonsurgical Treatments may be enough to treat symptoms and restore function. However, in other patients with spondulolisthesis that does not respond to nonsurgical treatments, an operation may provide some relief. For most patients with spinal instability, Lumbar Fusion may be recommended. For patients with nerve compression, Lumbar Decompression may be necessary to relieve pressure on pinched or damaged nerves. For the right patient, surgery may provide lasting relief (Reference: [1]).