Lumbar Spondylolisthesis

Degeneration and injury in the spine can lead to spondylolisthesis, a condition characterized by the slippage of a vertebra forwards, backwards, or sideways compared to the adjacent vertebrae. In this condition, a vertebra is displaced out of line with the other adjacent vertebra as a result of erosion of the bone and cartilage structures and also associated with laxity of the supporting ligaments.

Like all other spine disorders, conservative treatment often provides relief and pain doesn't become severe unless a nerve root is irritated. There can be components of both mechanical pain and neurological impingement pain.

There are two forms of spondylolisthesis:

Isthmic Spondylolisthesis: Small fractures at weak points in the vertebral bone separate and the front and back bone structures slip apart.

Degenerative Spondylolisthesis: Under the stress of gravity, weakened ligaments allow excess laxity in the spine while arthritic facet joint structures erode, allowing the upper bone structure to gradually shift forward.

Treatment involves reducing irritation and compression on the nerve roots using epidural steroid injections and selective nerve injections, as well as treating the associated facet syndrome with Prolotherapy to strengthen and shorten the surrounding ligaments, or radiofrequency neurotomy to dull the pain coming from the arthritic facet joints.

Surgery to decompress the nerve roots and stabilize the lax vertebra may be required in severe cases if the pain and neurological symptoms are not sufficiently responsive to aggressive non-operative management.