03/11/2022
What is spondylolisthesis?
Spondylolisthesis is the slippage of one vertebral body with respect to the adjacent vertebral body causing mechanical or radicular symptoms or pain.
Causes:
1. Repetitive stress to the pars interarticularis
2. Decreased strength of the neural arch at a young age predisposes children and adolescents to a higher risk of fracture.
3. Traumatic accidental injuries
4. Microtrauma in sports
5. Pathological causes - Neoplasm, connective tissue disease, etc.
6. Iatrogenic - After laminectomy
Adolescents and children also have more elastic intervertebral disks which cause increased stress to be placed on the pars interarticularis
Symptoms:
1. Patients typically have low back pain which mimics radiculopathy for lumbar spondylolisthesis and localized/radiating neck pain for cervical spondylolisthesis.
2. Pain is exacerbated by extending at the affected segment, as this can cause mechanic pain from motion, leading to diminished ROM (spine). Pain decreases as the patient assumes flexed posture which reduces stress on the nerve being impinged.
3. Pain may be exacerbated by direct palpation of the affected segment.
4. Pain can also be radicular in nature as the exiting nerve roots become compressed due to the narrowing of nerve foramina as one vertebra slips on the adjacent vertebrae, the traversing nerve root (root to the level below) can also be impinged through associated lateral recess narrowing, disc protrusion, or central canal stenosis.
5.Pain can sometimes improve in certain positions such as lying supine. This improvement is due to the instability of the spondylolisthesis that reduces with supine posture, thus relieving the pressure on the bony elements as well as opening the spinal canal or neural foramen.
6. Spondylolisthesis can also present as an acute or acute-onchronic episode with the patient having severe exacerbation of pre-existing back pain, neurological deficits, hamstrings spasm and a crouched gait.[7]The patient develops a crouched gait (Phalen-Dickson sign) due to the vertical position of the sacrum, lumbosacral kyphosis, compensatory lordosis of the proximal spine and flexion of the knees and hips, which may be present regardless of the degree of slippage.
7. Atrophy of the muscles, muscle weakness
Tense hamstrings, hamstrings spasms
Disturbances in coordination and balance, difficulty walking
Rarely loss of bowel or bladder control.
Treatment:
1. Initially resting and avoiding movements like lifting, bending, and sports.
2. Analgesics and NSAIDs reduce musculoskeletal pain and have an anti-inflammatory effect on nerve root and joint irritation.
3. Epidural steroid injections can be used to relieve low back pain, lower extremity pain related to radiculopathy and neurogenic claudication.
4. A brace may be useful to decrease segmental spinal instability and pain.
5. Physiotherapy focuses on relieving extension stresses from the lumbosacral junction (hamstring and hip flexor stretching), as well as working on core strengthening (deep abdominal muscles and lumbar multifidus strengthening).
6. Last stage- surgery .
