Lumbar Spondylolisthesis Lumbar spondylolisthesis is the medical term used to describe the slipping of a vertebra within the spinal canal. The human lumbar spine is a perfectly uniform S-shape, but the slippage distorts this shape. In lumbar spondylolisthesis, the lumbar spine (vertebrae) slides forward or backward over the underlying vertebrae. Slippage can be classified into five different types: degenerative, isthmic, developmental abnormalities/congenital, disease-induced, and trauma-induced slippage. The 5 types of slippage 1. Degenerative slippage of the lumbar spine: the most common degenerative disease causing it. It is usually present in older adults and is especially common in African Americans; 2. Isthmic lumbar slippage: affects adults and children. It usually results from a small break in one of the isthmuses (part of the articular eminence); 3. dysplastic slippage: also known as congenital lumbar slippage, it is the result of a congenital birth defect; 4. pathogenic slippage: this form of lumbar slippage is caused by a disease, such as a tumor or infection; 5. traumatic (traumatic) slippage: a fracture that results from a traumatic event. Lumbar slippage grade The severity of slippage is determined by the degree of slippage, or the percentage of slippage of one vertebral body versus another. The higher the slippage grade, the more severe the symptoms. Each of the four slippage grades represents 25% slippage. Although slippage from the lumbar spine can occur anywhere in the lumbar spine, it is most common in the low back and is the primary source of back pain. Even in many cases, slippage symptoms can be improved with non-surgical treatment, but severe slippage may require surgical treatment. Symptoms and causes of lumbar spondylolisthesis The symptoms of lumbar spondylolisthesis vary greatly from patient to patient and can vary from mild to severe in presentation. Some patients with lumbar spondylolisthesis may not even have any symptoms. In the early stages of the disease, symptoms may only manifest as painful sensations in the neck or back after activity. You can also check out our treatment page for more information. Lumbar spondylolisthesis 1. localized pain or radiating pain in the back, buttocks and/or thighs; 2. muscle tension or stiffness; 3. localized pressure and pain in the slipped segment; 4. decreased mobility in the low back; 5. numbness or tingling in the lower extremities; 6. decreased muscle strength in the lower extremities if not treated promptly. Causes of lumbar spondylolisthesis: Lumbar spondylolisthesis may be secondary to degenerative disease, fracture, congenital deformity, pathological bone loss, and traumatic injury. The symptoms of lumbar spondylolisthesis then arise from a slipped displacement of the lumbar spine. If lumbar spine slippage occurs in the cervical spine, you will feel symptoms in the shoulders, upper extremities, and hands. When the lumbar spine is slipped, you will feel symptoms in the lower back, buttocks, and thighs. Treatment of lumbar spondylolisthesis: Conservative treatment should be applied first before aggressive surgical intervention is undertaken for a first occurrence of lumbar spondylolisthesis. Conservative (non-surgical) treatment of lumbar spondylolisthesis includes physical therapy of the core muscles, application of anti-inflammatory medications, epidural injections, brace immobilization and strict bed rest. Conservative treatment methods such as rest and local braking can help relieve the symptoms of lumbar spondylolisthesis. Functional exercise, on the other hand, is very helpful in strengthening and rebuilding the stability of the lumbar spine. In addition, the use of epidural steroid injections and selective nerve root blocks can alleviate and eliminate the periodic sterile inflammation that occurs in the slipped segment. Through the use of the most advanced adjunctive tests and diagnostic tools, we will work with you to create an individualized lumbar spondylolisthesis treatment plan. The location of the lumbar spondylolisthesis, its severity, and how much it affects your symptoms in your daily life will help us determine what lumbar spondylolisthesis treatment plan is best for you. With our guidance, you will get the right treatment for your condition. Timing of surgery for lumbar spondylolisthesis: Surgery for lumbar spondylolisthesis should be considered if conservative treatment fails to produce positive results after 6-8 weeks or if the patient’s quality of life does not improve directly. Surgery is indicated prior to conservative treatment for patients with preexisting neurologic dysfunction, impaired bowel or bladder function, or progressive worsening of muscle weakness. In addition, surgical treatment should be considered if one or more of the following conditions are present: significant displacement of the slipped vertebrae beyond more than 50% of the adjacent vertebral facets, significant deformity in physical appearance, impaired walking gait, or pain in the legs. Diagnosis of lumbar spondylolisthesis: Similar to most other conditions that cause back symptoms, a diagnosis of lumbar spondylolisthesis requires three steps. First, your doctor will need to take a medical history to discover the timing of the first pain or other symptoms, whether there is a genetic history in your family, or what caused your current injury. You should also let your doctor know if there are specific positions that can increase or decrease your pain, or what you have done on your own to reduce your symptoms. Next, your doctor will perform a physical examination to assess the range of motion, flexibility and other physical symptoms of your lumbar spine. Finally, your doctor will also check muscle strength and go through some tests to check your nerve function. Imaging for lumbar spondylolisthesis: Because lumbar spondylolisthesis can affect the lumbar spine sequence, a simple x-ray can confirm the diagnosis when you are suspected of having this condition. If there is existing soft tissue damage, an MRI can provide a better diagnosis.