Spondylolisthesis is a medical condition where a vertebra slides forward on the adjacent vertebrae.
Symptoms
Lumbar spondylolisthesis is indicated by pain in the leg or the lower back. Incontinence of the bowel or the bladder may occur in situations where the condition is severe. Flexing the spine may cause the pain to worsen while pain can be reduced by stretching the spine. Cervical spondylolisthesis is characterized by pain at the back of the head, between shoulder blades and at the neck. In some situations, the pain may also be experienced in the arms and legs along with numbness and weakness. There is also bowel or bladder incontinence.
About this Condition
This condition refers to a situation where a vertebra shifts forward on a vertebra adjacent to it. This causes the vertebral canal to get narrow and also causes the spine to get deformed gradually.
A deformity is usually common and is slightly visible in patients suffering from spondylolisthesis. If the hamstring muscles in the legs begin to get tight, this is an early physical indication of spondylolisthesis. A deformity in the spine usually takes a while before it becomes noticeable. This is usually when the vertebrae have shifted forward to about 50 percent of the width of the vertebral body.
Treatment
Conservative Treatments
Injections
There are different types of injections which a doctor may administer to a patient. A corticosteroid injection is one example. By reproducing the effects of cortisone and hydrocortisone hormones in the body, this injection can reduce inflammation and reduce pain. This is achieved by injecting it in higher levels than the natural level. It may have some side effects, and, for this reason, it is administered in controlled numbers.
Combining a steroid with an anesthetic which is directly applied to the area where spinal nerves cause pain is another common method used. This combination is directed into this area by administering an injection. The area where the injection is administered is known as the dura. This is a membrane which provides protection for the nerve roots and spinal nerves. The anesthetic is responsible for making the body numb to pain while the steroid hinders the production of proteins in the body. These proteins are usually responsible for inflammation.
In the case of a diagnosis, an epidural spinal injection may be administered. The diagnosis is performed by administering the injection around the area where the pain causing nerve root is suspected to be located. It may also be used as a form of therapy to offer relief from pain. It is usually a short-term relief but may provide long-term relief in some cases.
Surgery
METRx Minimally Invasive Hemilaminectomy
In a case where the pressure on the spinal nerves in the lower back is to be reduced by the removal of a part of one of the two laminae, it is achieved by performing a Hemilaminectomy. It helps to significantly reduce pain in the back and the legs of a patient.
Anterior Cervical Discectomy with Fusion
This form of surgery involves making an incision in the crease found at the front of the neck. Through this incision, neural structures of the body can be accessed. The adjacent vertebrae may be fused, or an implant may be placed to make the spine stable and enable it to heal. There may also be a need to replace a disc with an artificial one. By performing this surgery, pressure which may result from a herniated disc or bone spurs can be reduced.
Open Laminectomy
An operation in which space is created for nerve roots by removing some of the bones around it is known as Laminectomy. The bony rim around the spinal canal is called the lamina. If it is responsible for creating additional pressure on the nerve roots or the spinal cord, a portion of it is removed by a surgeon.
Posterior Fusion
This is a type of surgery to stabilize the spine. It is usually done after any surgery that has to do with easing the pressure on nerve roots or the spine by the removal of a portion of bone or vertebrae. Posterior fusion may include fusion instrumentation and bone grafting. Instrumentation is done to make the vertebrae stay in place as the bone graft grows and merges it. Instrumentations are implants which may be Metal or non-metal which may include screws, plates, and rods. The bone grafts may be interbody or on the outside of the vertebrae.
Transforaminal Lumbar Interbody Fusion (TLIF)
This technique involves removing disc through the back of the body. A rough space is created by scraping the bones. Plastic or a metal cage is then inserted along with bone chips to make it possible for bone fusion of the vertebrae. This surgery makes it easier to achieve a stable spine without any additional surgery if it is performed with a posterior fusion.
Lumbar Artificial Disc Replacement Surgery
Artificial disc replacement surgery is a more modern surgery developed to treat degenerative disc disease in the lower back. The principle behind this surgery is that an artificial disc replaces an affected disc. This allows the lower back to function in its normal state and protects other discs from any increased stress that may cause a breakdown. As a newer form of surgery, there are still lots of unknowns with this type of surgery.
The most significant concern about this surgery is the likelihood of the need for a disc to be replaced in future. This is because there may be wear of the disc as it moves around in the body. This possibility increases since a lot of degenerative disc disease patients opting for surgery are quite young. This gives an extended period over which the disc will have to function.
The artificial discs are inserted from the front of the body into the spine. The spine where it is inserted is located under the vena cava. After the insertion of the disc, the vessels wedge themselves on the spine making it difficult to remove the disc.
