According to major researchers in spine medicine including Wiltse, Yochum and Rowe there have been no recorded cases of spondylolisthesis in a newborn and therefore the condition is not believed to be genetic.
Some physicians believe that repetitive trauma such as from certain sports may either cause or contribute to the development of spondylolysis. Rest is only necessary if the patient becomes symptomatic. Rest can help eliminate the pain, and when the pain resolves the patient can resume his or her normal activities. Often adolescents are pulled from their sports participation because of fears that their spondylolysis will lead to spondylolisthesis slippage of the affected vertebra and that the slippage will become so severe as to cause permanent damage or paralysis.
However, in published medical literature, there are no instances of a patient in a work, industrial, or sports-related environment that has experienced trauma causing spondylolisthesis to slip further and produce neurological deficit or paralysis. Sophisticated imaging modalities such as single-photon emission computed tomography SPECT bone scans and magnetic resonance imaging MRI scans of the spine now provide the ability to evaluate the physiological changes that are associated with spondylolysis.
This information allows for the important distinction between active and inactive spondylolysis. Steroid and local anaesthetic injections are sometimes used around compressed nerve roots or even into the fracture area of the pars for diagnostic purposes.
Researchers cite evidence of benefit for bracing with exercise in mild or even in more severe degrees of slippage.
However, a meta-analysis concluded that bracing was not likely to fulfil this function and did not confer added benefit. Lesions diagnosed at the acute stage and unilateral lesions were the best subgroups. This depends also on degree and aetiology. An exception would be in the case of significant instability or neurological compromise and in high-grade slips.
Surgical therapy involves fusing the affected vertebra with a neighbouring normally aligned vertebra both anteriorly and posteriorly. The intervertebral disc is usually also removed, as it is inevitably damaged.
The slipped vertebra may be realigned. Whilst most surgeons agree that decompression of the nerves is of benefit to patients, the benefit of realigning slipped vertebrae is uncertain. For example, when the spondylolisthesis is very gradual in onset, or in cases of congenital spondylolisthesis compensatory changes in the spine and musculature occur so that realignment may increase the possibility of further injury. There is good evidence that surgical treatment of symptomatic spondylolisthesis is significantly superior to non-surgical management in the presence of:[ 13 ] Significant neurological deficit.
Failed response to conservative therapy. Instability with neurological symptoms. Degree of subluxation of III or more. Unremitting pain affecting quality of life. A large systematic review concluded that reduction of displacement carried benefits over fusion alone, although a large retrospective review showed high complication rates, particularly for older patients with more severe disease.Spondylolisthesis should be treated first with conservative therapy and when this fails, surgery is referred. Clinical Orthopaedics and Related Research, , , — Usually, the bones of the lower back are affected. The next most common levels affected by degenerative spondylolisthesis are L3-L4 and L5-S1.
Surgical therapy involves fusing the affected vertebra with a neighbouring normally aligned vertebra both anteriorly and posteriorly. There are many different surgical procedures for spondylolysis and spondylolisthesis. Eur Spine J. The fact that there was wear of the brace, indicates that the brace has an important function in the sitting position.
Sophisticated imaging modalities such as single-photon emission computed tomography SPECT bone scans and magnetic resonance imaging MRI scans of the spine now provide the ability to evaluate the physiological changes that are associated with spondylolysis. May ; Spondylolisthesis is a condition in which one of the bones of the spine vertebrae slips out of place onto the vertebra below it. The defect in the pars interarticularis may allow anterior forward displacement or slippage of the vertebra which is called spondylolisthesis Figure 2. A combination of physiotherapy, hydrotherapy and clinical Pilates typically works well and is often recommended. Back pain is the most common symptom of spondylolisthesis.
It is a good aid during the painful periods but should be discontinued when the patients' complaints are reduced. Hu et al. How do People Get Spondylolisthesis? The upper vertebral body is displaced backwards relative to the vertebrae below. It is often advised that sports requiring extensive or repeated hyperextension be avoided if possible. The bone scan can also be useful in differentiating an acute stress reaction spondylolysis from a chronic defect.
For this rare condition, surgery is the only way to completely fix or heal spondylolisthesis of grade 5. Coordinative skills Figure 3: Strengthening of the deep abdominal muscles. Posture and lifting techniques Special attention has to be given to posture and proper lifting techniques  wherein the physiotherapist has an important educational role. Sports that involve hyperextension and rotation. Fortunately, spondylolisthesis conditions are typically not very severe, leaving grade 1 and grade 2 being the most frequent gradings. In addition, a bone stimulator is occasionally used for an acute spondylolysis to facilitate healing Figure 7.
This can be a fusion or Gill laminectomy.
Related Articles. Winkel, orthopedische geneeskunde en manuele therapie: de wervelkolom deel 2. Management [ 2 , 8 ] The goal of treatment is to relieve pain, stabilise the spinal segment and stop or reverse the slippage. This case demonstrates the potential instability of this condition in adults and has not been previously reported. Unremitting pain affecting quality of life. Lesions diagnosed at the acute stage and unilateral lesions were the best subgroups.
Journal of the Neuromusculoskeletal System. To diagnose this condition, your doctor will take X-rays in order to see if any of the bones in your vertebrae have slipped or are misaligned. Lateral spinal X-rays - will show spondylolisthesis. A radiologist determines the degree of slippage upon reviewing spinal X-rays.
The fractures themselves may not heal but it is thought that the muscles controlling the spondylolisthesis provide sufficient functional control to avoid painful symptoms. Iowa Orthop J.
The case details and images are reviewed and the intraoperative decisions, treatment options, and patient outcome are discussed. In degenerative spondylolisthesis, what usually happens is that ongoing degeneration weakens the facet joints and disc, and typically the L4 vertebral body slips forward on the L5 vertebral body. It is believed that the repetitive trauma can weaken the pars interarticularis and lead to a spondylolysis. Rest can help eliminate the pain, and when the pain resolves the patient can resume his or her normal activities.
Posture and lifting techniques Special attention has to be given to posture and proper lifting techniques  wherein the physiotherapist has an important educational role. Related Articles. Laterolisthesis is a side ways shift that is rare. Isthmic spondylolisthesis occurs most often at L5-S1, and is more often seen in younger adults than degenerative spondylolisthesis.
A radiologist determines the degree of slippage upon reviewing spinal X-rays. Short periods of bed rest can sometimes help with very painful episodes. This depends also on degree and aetiology. It is usually non-operative, and surgery is only necessary in a small percentage of patients. It is believed that the repetitive trauma can weaken the pars interarticularis and lead to a spondylolysis. In degenerative spondylolisthesis this will relate in part to the progress and prognosis of the underlying changes.