Lumbar Spondylolisthesis | Spinal Instability

What is Lumbar spondylolisthesis?

Lumbar spondylolisthesis or spine instability is a condition where one or more of the vertebrae in the lumbar spine (lower back) slips out of place onto the vertebra below it. This slippage can cause pressure on nerves, causing pain and limiting mobility. This condition occurs due to a variety of reasons, including degenerative changes, congenital abnormalities, and trauma. Lumbar spondylolisthesis is not the same as spondylolysis, a stress fracture in the spine, but they are related since spondylolysis may cause spondylolisthesis when a stress fracture causes the slipping. Doctor Andre M. Samuel, orthopedic spine specialist, treats patients in the Clear Lake, Houston, Sugar Land, TX area suffering from lumbar spondylolisthesis and instability.

What are the common causes of lumbar spondylolisthesis?

There are several different types of lumbar spondylolisthesis. The most common is degenerative spondylolisthesis. It occurs when arthritis causes the disc and facet joints of the spine to slowly wear out over time. This can lead to instability or slipping of one vertebral bone over another, causing pain.  

Other common types include:

• Congenital spondylolisthesis occurs when a person’s spine doesn’t form properly in utero, leading to slippage later in life.
• Isthmic spondylolisthesis is the result of a crack or fracture in the spine, sometimes occurring early in childhood and progressing later in life.

Who is at risk for spondylolisthesis?

Some people can live with lumbar spondylolisthesis for years without having any symptoms. The condition affects up to 6% of the adult population, is more common in those over 50, and tends to affect more women than men. Patients born with thinner sections of the vertebrae also tend to have a greater risk of developing the condition. Children and teens can also be at risk if they participate in sports that stretch the lumbar spine, such as gymnastics.

What are the first signs or symptoms of lumbar spondylolisthesis? 

Lumbar spondylolisthesis can cause a wide variety of symptoms or none at all. Pain can be mild or severe. Common symptoms include:

• Lower back pain and reduced range of motion
• Sciatica pain that radiates down one or both legs
• Muscle tightness or stiffness
• Numbness, tingling, or weakness in the legs or feet

In severe cases, patients may notice changes in their gait or posture.

How is lumbar spondylolisthesis diagnosed?

An X-ray of the lumbar spine is the most common imaging test used to show the alignment of the vertebrae and the extent of any slippage. Dr. Samuel may also order an MRI or CT scan to determine the condition of the surrounding nerves, discs, and soft tissues. He will always take a complete medical history and perform a thorough physical exam.

Once lumbar spondylolisthesis is diagnosed, Dr. Samuel grades the instability based on the severity of the condition and comes up with an individualized treatment plan.

• Grade I & II (Low grade) – Less than 50% slipped
• Grade III & IV (High grade) – Greater than 50% slipped

What is the treatment for lumbar spondylolisthesis?

Treatment for lumbar spondylolisthesis depends on the severity of symptoms and how much slippage there is. Conservative treatments are typically the first line of defense and may include:

• Rest and activity modification
• Physical therapy to strengthen the muscles that support the spine.
• NSAIDs and other over-the-counter medications to relieve pain.
• Spinal injections to reduce pain and inflammation around the affected nerves.

If conservative treatments don’t provide any relief or if there is nerve compression, surgery may be the only option. Surgical treatments typically involve spinal decompression with or without a spinal fusion. As with any treatment the goal is to reduce pain and restore function. Dr. Samuel discusses all options with his patients and makes sure they know all the pros and cons before treatment begins.