What is Spondylolisthesis:
spondylisthesis is slipping of one vertebra over other. It most commonly occours at L5 S1 level but may also occur at higher levels. There occurs a break in the pars area of vertebra which is usually and acquired defect in childhood. Men are affected twice as much as women and risk factors include gmanastics, pole vaulting, weight lifting, dancing and football which create excessive lordosis and hyperflexion at lumbar spineSigns and symptoms:
most of the times spondylolisthesis is a symptomatic. When symptomatic, it gives rise to low back ache that may radiate to the buttocks, groin and thighs. Pain is typically more standing or walking than while lying flat. It may cause nerve compression giving rise to tingling, numbness and weakness in lower limbs. Some patients complain of neurogenic claudication ie onset of pain after walking a short distance which is relieved on sitting in a stooped posture.Diagnosis:
it can be diagnosed on Plain X rays of the lumbar spine which reveals the pars defect and the degree of forward slip of vertebra. Oblique x rays help to delineate the pars defect more clearly. CT scan is another imaging technique to diagnose the lysthesis. MRI is an excellent method to evaluate for degree of compression on nerves in spondylolisthesis. It also helps in planning the futher treatment.Fate:
spondylolisthesis in children and adolscents can progress rapidly due to growth potential and warrants early surgical interventions.
In adults however the deformity is static and has less chances of progression. In about 3 out of 10 patietns the slip may increase or there may be increasing compression on nerve roots needing operative treatmentTreatment:
7 out of 10 patients get better with non operative treatment consisting of exercise and medications with some form of bracing.
In patients who do not respond to non operative treatment surgery becomes the treatment of choice. The decision of surgery depends on the factors like
age of patient
clinical and radiological picture
physical demands of patient
general health and well being of patient
Surgery for spondylolisthesis is called Micro decompression with Interbody fusion. This procedure is done under general anaesthesia with the help of sophisticated microscopes and imaging devises. The pressure on nerve roots is released and the slip is reduced. The vertebrae are fixed over each other using screws and cages.Is surgery safe?
Even though it is a major surgery, with experienced and well trained surgeon in a good operative set up, this surgery has become safe and results are predictablePost op:
The patient typically has to stay in hospital for a period of 5-6 days after which he can be discharged