Spondylolisthesis – What Is That?

Anna was competing in a gymnastics tournament last year and during one of her floor routines, noticed a sharp pain in her low back after performing a series of back hand springs. She said she landed crooked on the last of four back hand springs which resulted in immediate pain in the middle of the low back at the beltline.  She has had pain in the low back before and initially, didn’t think this was any different from past episodes but when the pain didn’t improve after a week, she asked her parents if she could see their chiropractor for an adjustment.  Her chiropractor took her history and was alerted by the mechanism of injury – the rapid onset of pain after bending backwards and landing crooked during her routine.  The low back was carefully examined and during the range of motion testing, Anna’s backward bending test was very painful and limited in motion.  When bending backwards at an angle with pressure applied in the low back, sharp pain stopped the test immediately.  Her neurological tests were normal and she could bend over and touch her toes – in fact, that felt good.  Her chiropractor had a strong suspicion of what had happened and ordered an x-ray to see if the preliminary diagnosis was accurate.  The x-rays looked normal but with the history of extreme backward bending and immediate pain onset, a bone scan was ordered which was positive for a stress fracture in the back part of the vertebra.  Unfortunately, this meant no gymnastics for 3 months and the use of a low back brace was recommended.  The good news is that the back pain was gone within a month and follow-up x-rays 3 months later did not reveal a visible fracture line in the vertebra.  Anna was able to resume gymnastics and competed with success and no low back pain.

So, what is spondylolisthesis? As depicted in the side view low back x-ray (left), it is the sliding forward of one vertebra over another (see arrow). It occurs in about 7% of the population and up to 30-50% in cultures that carry their young on their back (like a back pack).  It is reported that most people who develop a spondylolisthesis acquire this between ages 6 and 16 due to a developmental weakness in that part of the spine, though more research is showing that the cause is due to trauma.  It can also gradually occur over time (called “degenerative”), usually not found before age 50-60, where no single event can be recalled by the patient. There is also a type called a pending spondylolisthesis where a fracture occurs without slippage.

The good news is that “spondylos” are mostly stable and do not require surgery.  In the more severe case, the nerves and/or spinal cord can get pinched, in which case surgery is necessary.  The symptoms would then include leg pain, weakness, and/or numbness with or without significant low back pain. Most cases however, can be successfully managed without surgery and do not compromise the nerves or cord.

Chiropractic has been found to be very successful in managing patients with spondylolisthesis as the pain generator is often above or below the slipped vertebra.  In fact, in one report, chiropractic was found to be more beneficial than medical care for this condition (Mierau D, et.al., J Manip Physiol Therap 1987;10:49-55).   For more information on back pain log onto, www.newbackpainreliefinfo.com

IF YOU HAVE A SPONDYLOLISTHESIS YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE ! FOR A FREE NO-OBLIGATION CONSULTATION CALL 262-251-8306

What is a Spondylolisthesis?

Spondylolisthesis pronounced,  \ˌspän-də-lō-lis-ˈthē-səs\   or spondylo for short.

Spondylolisthesis is a big word that describes a condition where a vertebra has slipped forward on top of the one below it.  The vertebra can slip so far forward that it can choke off nerve roots in the spine and cause shooting pain.

A spondylolisthesis is most commonly found on the very lowest vertebra (L5) or the one above it (L4).  Although, I have seen them at higher levels in the spine on rare occasions.

The most common cause of a spondylolisthesis is a stress fracture.  The fracture splits the vertebra so that the front part slips forward and the back part stays where it is.  Sometimes you can feel around with your fingers and find a divot where the spine dips in, just above the involved vertebra.  The stress fracture usually occurs during physical activity during adolescence, but they can occur at other times.

Sometimes the fracture is missed on standard imaging because no slippage has occurred.  This is called a pending spondylolisthesis and only shows up on a study called a SPECT scan.

The odd thing about spondylos is that many people have them and don’t even know it.  It may happen to you as a teenager and you may have little or no pain at that time.  However, if your posture deteriorates or you injure the area, it can flare up and cause a lot of pain.

Spondylo patients can be treated with chiropractic, but not all techniques work well.  Since the vertebra is already forward, a technique that will push it more forward, is obviously not advisable.  The main goal of treatment is to correct the patient’s posture, so that there is less stress in the area of the spondylo.  That can give a lot of pain relief.

Treatment is followed up with home instructions for care that will help prevent re-aggravation.

To learn more about how I treat spondylolisthesis log onto www.newbackpainreliefinfo.com.  Or if you would like to set up a free consultation to see if I can help, call Jennifer at 262-251-8306.