Degenerative Spondylolisthesis

Degenerative spondylolisthesis typically results from age-related changes in the spine. Key factors contributing to this condition include:

• With aging, the discs between the vertebrae lose water content and height, becoming less effective as shock absorbers and leading to increased motion between vertebrae.
• The facet joints, which help stabilize the spine, can develop arthritis over time. This degeneration can cause the joints to become less stable and allow one vertebra to slip over another.
• The ligaments that support the spine can weaken and become lax with age, contributing to the instability that leads to vertebral slippage.
• It is often associated with spinal stenosis, a narrowing of the spinal canal that compresses the spinal cord and nerves.

Symptoms vary depending on the severity of the slippage and the degree of nerve compression. The main symptoms include:

1. persistent low back pain
2. leg pain, sciatica
3. numbness and tingling due to nerve compression
4. pain and cramping in the legs
5. difficulty walking or maintaining balance

Dr. Colman will review your medical history and inquire about your symptoms. He will perform a physical examination to evaluate your pain, range of motion, and neurological function. Imaging studies including X-rays, MRI, and a CT scan will be ordered. X-rays will show spinal alignment and the degree of slippage. An MRI can provide detailed images of soft tissues, including discs, nerves and the spinal cord to aid in assessing nerve compression. A CT scan will offer details of the bones and help to evaluate the facet joints and reveal bone spurs.

Options include conservative measures and surgery and depend on the severity of your symptoms.

Conservative nonsurgical management

A trial of nonoperative management with rest, activity modification, anti-inflammatory medications, pain management, and physical therapy may be recommended. Epidural steroid injections can help reduce inflammation and provide significant pain relief. Surgery is indicated for progressive disabling pain that fails to resolve with conservative management, and/or progressive neurological deficits.

Surgery

• Decompression surgery without instrumentation involves the removal of bone and tissue that is compressing the nerves, providing relief from sciatica and other neurological symptoms. This is called a lumbar laminectomy.
• Spinal fusion surgery may be recommended to stabilize the spine when there is significant spinal instability or need to improve alignment. This involves the fusion of two vertebra together to prevent continued slippage and reduce pain. Common techniques to do this include:
  • Posterior lumbar fusion
  • Lateral lumbar fusion
  • Anterior lumbar fusion
• Post-operative physical therapy is essential for successful recovery. It can help restore strength, flexibility and mobility.