Spondylolisthesis - What Is it?
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In adolescents, back pain may start as the bones start to shift and become irritated due to the abnormal connection in the spine. Children who are active in sports and athletic activities will experience instability related to a lack of connection in the back bones that will start to be painful. X-rays, taken at this time, may show a break in the bones; however, there are a significant number of these kids with back pain who will have normal looking x-rays. These children may need to have a further evaluation with a CT scan to help visualize the bones of the spine more specifically. Many individuals live their whole lives with a break in their vertebrae and are pain-free until their discs start to degenerate.
The largest group of patients with spondylolisthesis have degeneration in the discs that leads to back pain and doctor visits is the middle age population. As the discs degenerate, they are not able to support the weight of the spine, which allows the bones to shift. Due to the change in the position of the bones, the discs will have to bear the brunt of the patient’s bodyweight and movement, which in turn, applies more stress to the discs and forces them to degenerate faster.
The back or leg pain associated with a mild slippage of the bones will not be any more severe than the normal pain associated with age. There are no particular restrictions in activities that need to be considered in mild spondylolisthesis. However, as patients get older, the discs that are between the slipped bones will continue to degenerate. Disc cartilage degeneration can be painful and can lead to an increase in the slippage of the bones. As the spine continues to degenerate and slip, the nerves that are protected by the bones will begin to receive pressure from the discs and bones. Pinching the nerves in the back will cause pain in the distribution of the nerve roots. This pain is felt in the back of the legs and down to the foot, called sciatica. Nerve pain is usually the most painful, and patients will be curious as to why the doctor is checking the back when it is the leg that hurts so bad.
The initial treatment for low back and leg pain related to spondylolisthesis is a physical therapy program and anti-inflammatory medications. Exercise, stretching, traction, as well as manual therapies, can be very helpful in relieving the pain. The goal is to try to relieve the pressure on the nerve and mobilize the bones and discs to allow for a more fluid motion of the back without irritating the muscle, tendon or nerves. Most patients respond favorably to this treatment and can maintain their spines with exercise at home. If this treatment is not successful, injections of steroids around the nerves and joints may be helpful in relieving some of the acute pains. After pain reduction, the exercise program may be more effective. If all of these treatments don’t work, surgery should be considered to relieve the back and leg pain. Although, most patients are reluctant to have back surgery, with the improved techniques used by the fellowship-trained orthopaedic spine surgeon, spondylolisthesis is one of the conditions of the spine that responds very successfully to surgery.
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