Spondylolisthesis: Causes, Grades, and Treatment
Spondylolisthesis is a condition in which one vertebra slips forward over the one below it. This can cause chronic back pain, gait disturbance, and compression of the neural structures.
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What is spondylolisthesis
In spondylolisthesis, the upper vertebra slides forward relative to the lower one. The L4-L5 and L5-S1 levels are most commonly affected. The condition may be congenital, result from a defect in the vertebral arch (spondylolysis), or develop due to age-related degenerative changes.
Grades of slippage
The Meyerding classification defines the degree of vertebral displacement:
- Grade I: up to 25% slippage, observation and conservative treatment
- Grade II: 25-50%, active treatment, surgery may be considered
- Grade III: 50-75%, surgical treatment recommended
- Grade IV: over 75%, operative intervention indicated
Progressive vertebral slippage poses a risk of nerve root and spinal cord compression. If neurological symptoms worsen, such as increasing leg weakness or loss of bladder and bowel control, urgent surgical consultation is essential.
Symptoms
- Chronic lower back pain that worsens with activity
- Pain radiating to the buttocks and legs
- Stiffness in the lumbar spine
- Hamstring tightness
- In severe cases: leg weakness and sensory changes
Diagnosis
The diagnosis is confirmed by lateral lumbar X-rays. Flexion-extension (dynamic) films reveal instability. MRI evaluates the condition of neural structures and intervertebral discs. CT scanning provides detailed bony anatomy.
Most patients report a marked reduction in pain and a return to their usual activity after fusion for spondylolisthesis. The result depends on the grade of slip, general health, and rehabilitation.
Treatment options
Conservative treatment
For Grade I with mild symptoms, treatment includes core-strengthening exercises, activity modification, anti-inflammatory medications, and physical therapy aimed at stabilizing the spine.
Spinal fusion
When slippage progresses or pain persists despite conservative care, spinal fusion stabilizes the affected segment using pedicle screws and an interbody cage. The procedure eliminates instability and decompresses the neural elements.
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