Spondylolisthesis

Spondylolisthesis is a common diagnosis in patients who experience chronic back pain with or without sciatica (pinched nerve pain in the legs). This condition represents the slippage of one vertebra relative to another. The most common types are referred to as isthmic or degenerative spondylolisthesis. This diagnosis is usually made by simple x-ray although advanced imaging such as MRI or CT scan can provide useful additional information. Most patients with these conditions can be managed non-surgically, many will, however, progress over time to require surgical treatment.

Isthmic Spondylolisthesis
This condition is commonly diagnosed in adults between the ages of 30 – 50. The usual presenting complaint is chronic back pain with sciatica. X-rays will usually demonstrate a slippage between the 5th lumbar and 1st sacral vertebrae although other vertebrae may also be affected. The underlying cause is a stress fracture affecting the L-5 vertebrae which usually occurs during adolescence but is frequently asymptomatic at the time. This condition commonly becomes symptomatic in young adulthood due to degeneration of the disc between the affected vertebrae. As the disc breaks down back pain ensues and abnormal motion results in irritation of the associated nerve roots producing radicular (sciatic) pain. Common treatments include physical therapy, epidural steroid injections, and surgical management. For patients who fail to respond to symptomatic treatment surgical treatment consisting of laminectomy and fusion represents the standard of care. Numerous studies have demonstrated superiority of surgical treatment to symptomatic care in the intermediate and long term.

Degenerative Spondylolisthesis
Degenerative spondylolisthesis is a manifestation of the normal ageing processes of the lumbar spine. Like isthmic spondylolisthesis this condition usually presents with low back pain, sciatica, or neurogenic claudication (pain or cramping in the legs experienced with standing or walking). This most commonly occurs in the 40 – 70 year old age group and is significantly more common in women. Although symptomatic treatment is commonly recommended, the condition is usually progressive and frequently results in the need for surgical treatment. Like isthmic spondylolisthesis, degenerative spondylolisthesis is best treated with laminectomy and fusion. Although select patients can be treated successfully with a non-fusion procedure, numerous studies have demonstrated superiority of decompression and fusion in the intermediate and long term.