In a healthy spine, each vertebra aligns perfectly with the one above and below it, kept in place by small joints called facet joints. This keeps the spine strong and flexible allowing for flexion, extension and rotation as well as bending from side to side. Spondylolisthesis occurs when one vertebra slips forward over the bone beneath it, potentially putting pressure on the spinal cord or nerves nearby.
Sometimes there are no symptoms for many years, or symptoms are vague and intermittent. Spondylolisthesis in the lumbar spine most commonly leads to back pain that radiates down the legs, worse with standing and walking. This condition is known as sciatica. Spondylolisthesis in the cervical spine can lead to pinching of the spinal cord, which can cause difficulty with balance, falls, changes in handwriting, and difficulty with fine manipulative tasks, such as buttoning buttons or tying shoes. This collection of symptoms is known as myelopathy.
Spondylolisthesis has several possible causes:
Dr. Oshtory performs a physical exam before recommending a series of diagnostic tests, like an X-ray, CT scan, or MRI that allow him to examine sections of your spine and locate the spondylolysis. In some cases, a special nuclear medicine scan called SPECT is required to make the diagnosis. He then grades the severity of your spondylolisthesis by measuring the amount of slippage, which can vary from less than 25% of the total width of the vertebra to a situation where the slippage is more than 100% — when the top bone has slipped all the way forward off the lower bone.
It’s important that spondylolisthesis is correctly diagnosed and treated as it can lead to severe pain and loss of function, weakness, and sometimes even a loss of bowel and bladder control.
Dr. Oshtory usually starts with nonsurgical therapies such as activity modifications, pain medication, and physical therapy to strengthen the muscles around your spine.
If you are still in extreme pain or if there is a risk of more nerve or spinal cord damage, Dr. Oshtory may recommend surgery. Proper surgical techniques can restore the normal spinal alignment, relieve pressure on the nerves or spinal cord, and restore the overall stability of the spine. Make an appointment so Dr. Oshtory can develop an individual treatment strategy to meet your unique needs.