Spondylolisthesis is a Latin-derived term meaning slipped vertebral body (spinal bone). A condition when a vertebra slips out of position. [1]

“Spondylo”= vertebrae

“listhesis”=slippage

Retrolisthesis

Is a posterior displacement of a vertebra.

Types of spondylolisthesis

Spondylolisthesis can be classified by into five groups (Newman 1976):

Group 1: dysplastic

  • Developmental malformation of the L5–S1 joint
  • Usually slight slippage

Group 2: isthmic

  • Stress fractures of the pars interarticularis (bridge of bone), which is critical for lumbar stability
  • Usually increased slippage

Group 3: traumatic

  • Severe separation of the laminae from the spinous process as a result of fractures
  • Marked slippage may occur

Group 4: degenerative

  • This usually results from wear on the discs and facet joints
  • Sometimes occurs or increases after decompressive surgery (laminectomy) for lumbar stenosis
  • A variable degree of slippage may occur

Group 5: pathological

  • Local disease weakens the pedicles, and a slip occurs
  • Tumour and infection are the usual causes

Grading

Spondylolisthesis is graded according to the severity of the slippage (Mayerding classification):

Grade 1- <25% slip

Grade 2- 25-50% slip

Grade 3- 50-75% slip

Grade 4- 75-100% slip

When one vertebra slips entirely off the one below (>100% slip), this is known as spondyloptosis. [3]

Symptoms

Back pain is the most common symptom of spondylolisthesis. This pain is typically worse with activities such as bending and lifting, and often eases when lying down.

As the spine attempts to stabilise the unstable segment, the facet joints enlarge (hypertrophy) and place pressure on the nerve root causing lumbar spinal stenosis and lateral recess stenosis. Furthermore, as one bone slips forward on the other, narrowing of the intervertebral foramen may also occur (foraminal stenosis).

Severe nerve compression can therefore occur with pain, numbness and weakness in the legs. Sometimes loss of control of the bladder and/or bowels can occur due to pressure on the nerves going to these important structures. [3]

Treatment

  • Strengthening M. erector spinae
  • Acupoint-Therapy
  • No heat treatments
  • No treatments to release the muscles around the Spondylolisthesis

Operation techniques

Four types of fusion surgery are commonly recommended for the treatment of spondylolisthesis, depending upon individual patient factors:

  • Transforaminal lumbar interbody fusion (TLIF)
  • Posterior lumbar interbody fusion (PLIF)
  • Instrumented posterolateral fusion (pedicle screw fixation and posterolateral bone graft)
  • Anterior lumbar interbody fusion (carried out through the abdomen, rather than from the back) [3]
PLIF system with cage (Pina Medizintechnik)

Reference:

[1] American Academy of Orthopedic Surgery. (n.d.). Spondylolysis and Spondylolisthesis.

Retrieved 01 October 2013 from http://orthoinfo.aaos.org/topic.cfm?topic=a00053

[2] Pina Medizintechnik. (2013). Dynamic PLIF System. Retrieved 01 October 2013 from

http://www.pina-med.de/en/products/details.php?productid=9

[3] Precision Neurosurgery. (n.d.). Spondylolisthesis. Retrieved 01 October 2013 from

http://www.precisionneurosurgery.com.au/html/conditions_spond.htm