Degenerative spondylolisthesis

Degenerative spondylolisthesis

Degenerative spondylolisthesis is a condition in which a bone (vertebra) in the lower part of the spine (lumbar spine) slips out of its proper position due to degenerative disease such as arthritis. This "slip" usually occurs between the fourth and fifth lumbar vertebra and compromises the normal stabilizing structures of the spinal column.

Some people with degenerative spondylolisthesis are symptom-free and discover the disorder only when seeing their doctor for another health problem. In severe cases of degenerative spondylolisthesis, the forward slip of the vertebra often leads to spinal stenosis (narrowing of the spinal column), nerve compression, pain and neurological injury.

Causes

Over time, arthritis in the little joints (facet joints) between the vertebrae of the spine causes them to wear down, degenerate and loosen. As a result, the vertebra above the degenerated facet joint slips forward under gravity's pull. Degenerative spondylolisthesis most frequently happens to women over the age of 60.

Symptoms

You may experience one or more of these symptoms:

  • Mild to severe lower back pain
  • Pain, especially after exercise, in the lower back, thighs and/or legs that radiates into the buttocks and/or down the legs (sciatica)
  • Leg weakness
  • Irregular gait or limp
  • Muscle spasms
  • Tightness in hamstring muscles
  • Pain in your thighs and buttocks
  • Stiffness
  • Tenderness in the area of the slipped vertebra

Degenerative spondylolisthesis eventually can increase swayback (lordosis) and in later stages, kyphosis (roundback) as the upper spine falls off the lower spine.

Types

Degenerative spondylolisthesis is one of five types of spondylolisthesis, including:

  • Isthmic spondylolisthesis – caused by a defect in a portion of the vertebra called the pars interarticularis
  • Dysplastic spondylolisthesis – caused by a congenital defect in the formation of joints known as facet joints that connect the vertebrae
  • Traumatic spondylolisthesis – caused by direct trauma or injury to the vertebrae
  • Pathologic spondylolisthesis – caused by a defect in the vertebra from a tumor or other bone abnormalities

Treatment

According to the National Institutes of Health (NIH), surgery for degenerative spondylolisthesis is rarely needed. Most patients can manage their symptoms with activity modification such as short periods of rest, avoiding standing or walking for long periods and avoiding active exercise and activities that require bending backwards.

The multidisciplinary team of spine experts at Northwell Health Orthopaedic Institute treats degenerative spondylolisthesis as well as a broad range of spine conditions that can occur at any stage of life.

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