Slipped vertebrae/ Spondylolysthesis
Spondylolisthesis is when a spinal vertebra slip forward over another vertebra caudal to it. There are different types of the condition, depending on the anatomical changes.
Spondylolytic lysthesis: It is caused when the crack in a pars fracture affects both sides of connection (between the lamina and pedicles). The condition can be a direct result of spondylolysis.
Degenerative spondylolisthesis: Usually seen in elderly age group, this condition is caused by the deterioration of the facet joints and discs of the spine.
Congenital spondylolisthesis: Usually seen in the younger age group, this condition is caused due to birth defects in the bony structure of vertebrae (predominantly pars).
The evaluation for this condition will usually involve a review of the patient’s medical history and a physical examination, followed by standing X-rays, which can grade lysthesis. Your doctor may advice dynamic radiographs to evaluate if the lysthesis is stable or unstable.
A CT scan may be used to evaluate a pars defect or any bony problems, while an MRI may be useful to assess the surrounding tissue, nerves and condition of the disc.
Treatment depends on the clinical symptoms.
Conservative treatment: If the person is asymptomatic or has only back pain / stiffness, then surgery is NOT the first choice. Bracing / exercises and physiotherapy may be tried, which can give satisfactory results.
Surgical treatment: Surgery is recommended if conservative treatment doesn't give good results and / or if the patient has neurological symptoms like leg pain / numbness / bladder symptoms.
Surgery involves decompressing the nerve roots and fixing the bone with or without reducing the lysthesis by using screws and bone graft.