The Bonati Institute Glossary: Spondylolisthesis

The mission of The Bonati Institute is to provide hope to people suffering with chronic pain from a back or neck condition. We believe that a well-informed patient is vital to restoring hope and finding answers to pain. We developed this web site primarily to help educate pain sufferers and their families. We’ve found that the more individuals in pain learn about their anatomy, their condition and the options available to them the more likely they will be to choose the advanced arthroscopic procedures offered by The Bonati Institute.

Spondylolisthesis

Spondylolisthesis describes a condition of forward slippage of one vertebrae in the spine over another. This condition in adults is most commonly due to degeneration (wear and tear) of the discs and ligaments that bind and support the spine. With aging, discs lose water content and ultimately height. As the vertebra on either side of the disc come closer to each other through the loss of disc height, the upper vertebra slides forward on the sub adjacent vertebra producing spondylolisthesis.

In some patients spondylolisthesis may have developed in childhood. In degenerative adult spondylolisthesis the most common forward slippage is of the L4 vertebra over L5 vertebra. High stresses and motion produce degeneration of the disc and for this reason the most susceptible levels of the lumbar spine are L4-L5, followed by L3-L4 and L5-S1... Although back pain is the most common symptom of this condition, when nerve compression occurs then numbness in the legs, heaviness, tingling and weakness may also develop, particularly with walking, prolonged standing and other activities.

Spondylolisthesis can cause compressive (or neurogenic) type symptoms. The forward slip of the vertebra also makes the spinal canal smaller, leaving less room for the nerve roots. The compressive symptoms can arise because the nerve roots at the segment involved are pinched. There is usually pain across the small of the back and into the buttocks. If there are compressive symptoms, there may be pain down the leg to the foot, numbness in the foot and possibly weakness in trying to raise the foot.

Diagnosis

Imaging tests, such as MRI and CT scans are very helpful in demonstrating the degree of spine slippage in spondylolisthesis and any resulting stenos is, or a 'pinched nerve' in a narrowed spinal canal. Most of the symptoms of spondylolisthesis are aggravated by standing, walking and other activities

Spondylolisthesis is also associated with deterioration of the facet joints connecting the two vertebra. As the facet joints become arthritic due to this deterioration, they enlarge in an attempt to confer stability. As the two rings of the vertebral segments which make up the spinal canal, slide past each other, the canal narrows in size. The combination of canal narrowing and enlargement of the facet joints produces the characteristic nerve compression problems found in degenerative spondylolisthesis. The nerves are compressed in two major areas at the site of a degenerative spondlylolisthesis. It is believed that a reduction in nerve blood flow accounts for the symptoms produced from spinal canal narrowing (spinal stenosis).

Probable Treatment

The Bonati Arthroscopic Laminectomy

Surgery may be necessary if physical therapy and exercise treatments fail to keep the pain at a tolerable level. Surgical treatment for spondylolisthesis must address the nerve compression symptoms if they are present. This usually means that the nerves that exit the spine must be freed of all pressure and irritation. This is usually done by performing a laminectomy.

The back of the vertebra is called the lamina. This small, thin bony spinal structure located at the back of the spine covers access to the spinal canal and spinal cord. A laminectomy removes a portion of the lamina. Removing a portion of the lamina gives the surgeon access to the spinal canal so that the surgeon can create more room for the nerves of the spine and thereby reduce the irritation and inflammation on the nerves.