How does Spondylolisthesis / Anterolisthesis occur?

The causes of spondylolisthesis can be broken down into five different categories:

1. Degenerative: spinal joint wear and tear causing degeneration.

2. Traumatic: a traumatic event that results in immediate slippage or degeneration.

3. Pathologic: can occur following infection or cancer.

4. Isthmic: due to a defect in the bone known as ‘pars interarticular.

5. Dysplastic occurs when there is a defect during the developmental stage of the vertebrae, which changes the structure of the bone, increasing susceptibility to slippage.

Degenerative Spondylolisthesis is more common in adults over 50 years old and most commonly affects the L4-L5 region of the lumbar spine or, simply put, your lower back. As the lumbar discs go through degenerative changes, they become more susceptible to repetitive micro-traumas from hyperextension movements. The additional stress placed on the discs during hyperextension can further reduce the vertebral stability and increase the vertebrae's translation or ‘sliding.’

What are the symptoms of Spondylolisthesis / Anterolisthesis?

In many cases, people don’t even know they have spondylolisthesis, as minor cases are not likely to cause any discomfort. In more moderate to severe cases, individuals may experience:

• tenderness around the affected area,

• back stiffness,

• increased pain and discomfort when standing or walking for extended periods,

• pain when bending forward, and

• numbness and tingling in the leg and foot

What should you avoid doing if you have Spondylolisthesis / Anterolisthesis?

Individuals diagnosed with spondylolisthesis should minimize high-impact activities, extended periods of walking or standing, and heavy lifting movements as extreme pressure on the vertebral bodies have a large amount of compression placed on them, increasing the likelihood of further micro-traumas or slippage.

What treatments are there if you have Spondylolisthesis / Anterolisthesis?

There are surgical and non-surgical options that can be appropriate depending on the severity of the condition.

Non-surgical treatments include:

• Medication: over the counter anti-inflammatories may assist with pain relief.

• Injections: cortisone injections directly into the affected area have been very successful in relieving pain but are usually only temporary (2)

• Physical therapy: exercises tailored to your condition can help with long-term pain relief and usually target back and abdomen strength.

• Bracing is commonly used with younger patients to limit spine movement and allow fractures to heal.

Surgery may be the most suitable option for severe cases of spondylolisthesis where no non-surgical treatments were found to be effective. The surgery aims to relieve the irritated nerve, realign the spinal segments that have slipped, and restore the overall function of the spine (1).

Surgery for spondylolisthesis can be done with or without spinal fusion, depending on what is recommended in your case. After surgery for the spinal fusion of two vertebrae, the bones will eventually fuse and result in limited spinal flexibility in that segment (1)

How can Osteopathy help with Spondylolisthesis / Anterolisthesis?

As Osteopaths, we will, of course, use manual therapy to help relieve tension and increase range of motion, but it is also important for us to educate you on your condition as you need to understand what is happening in your body so you will know what you can do to keep it healthy.

We may advise you on how to develop better habits throughout the day, at work and home, continue good posture, and add or remove items to increase ergonomics. Maintaining a healthy weight is also important for patients with this condition, as increased fat can increase the risk of worsening the situation or preventing healing.

Specific exercises will also be prescribed to increase the spine's strength, flexibility, and stability and further reduce pain and symptoms long-term.

 Reference:

1.       Tenny S, Gillis CC. Spondylolisthesis. [Updated 2021 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430767/

2.       Sencan, Savas, et al. ‘The Effect of Transforaminal Epidural Steroid Injections in Patients with Spondylolisthesis.’ 1 Jan. 2017: 841 – 846.

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