ABOUT
Spondylolysis is a defect or fracture of part of the vertebral bone called the pars interarticularis. It usually occurs in the fifth lumbar vertebra and, less commonly, in the fourth lumbar vertebra. Spondylolisthesis is forward slippage of one vertebral body on top of another.
The exact cause of Spondylolysis is unknown, it can be attributed to genetics, overuse activities (particularly those with hyperextension involvement such as gymnastics), and previous surgery. Spondylolisthesis occurs when there is a weakening of the restraining structures of the spine. This can be due to spondylolysis, congenital factors, degeneration of the spine, trauma, and cancer.
SYMPTOMS & DIAGNOSIS
Patients have pain in the back because of the unstable movement of the vertebra. Leg pain is caused because of pressure on the nerves. The other symptoms are as below
Most people with spondylolysis/spondylolisthesis are asymptomatic and are unaware they have the condition. When symptoms are present, however, they may include
- Low back pain
- A feeling of tightness in the back of thighs
- Pain radiating down the legs
- Difficulty with upright posture and gait.
Usually, after a complete history and physical examination, your doctor may be able to diagnose a spondylolisthesis. Diagnostic procedures are required to confirm the diagnosis. Diagnostic procedures for spondylolysis /spondylolisthesis may include the following:
- X-rays are the initial investigation and provide confirmation of the diagnosis as well as the probable cause. Sometimes special X-rays are taken while bending forward and backward may be required for further assessment.
- Magnetic Resonance Imaging (MRI)– MRI scan is an essential part of the investigation for spondylolisthesis as it delineates the nerves and the compression on them.
TREATMENT
The patient may be treated surgically or non-surgically. Treatment can only be decided after thorough examination and investigations. Every patient will have to be individually evaluated and after considering the extent of the spondylolisthesis/spondylolysis, age of the patient, a treatment protocol be decided.
Most patients with spondylolysis/spondylolisthesis have acute episodes of pain with intervening pain-free periods. These symptoms usually improve with rest and time. To help relieve the pain, treatment may include analgesics (pain killers), belts/ braces, physiotherapy, limiting your activities.
Patients who have one or more of the following symptoms may require surgery.
- Worsening of back pain or persistent leg pain with no improvement even with adequate rest and analgesics.
- A weakness of the legs,
- Disturbance of bowel or bladder function
- Progressive forward slipping of the vertebra
The goals of surgery are to prevent further slipping of the vertebra and relieve the pressure on the spinal nerve.
- Posterior Instrumentation and Fusion- Fusion is the surgery by which the two abnormally moving vertebrae are made to join and become a single unit. Instrumentation (stabilization) is the use of metal plates, screws and rods to hold the vertebrae in position till they fuse.
- Transforaminal or Posterior Lumbar Inter-body Fusion (PLIF) - In addition to Posterior Instrumentation and Fusion, metal cages are placed in between the vertebral bodies to achieve a solid fusion.