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Q: What is Spondylolisthesis?  Is it the same thing as scoliosis? (I know it’s not but everyone I tell says “Oh. Scoliosis?”)

A: You are right; a spondylolisthesis is not the same thing as scoliosis.  Spondylolisthesis is the slippage or displacement of a vertebra relative to the one next to it, whereas scoliosis is an abnormal curvature in the spine.  When someone talks about having a spondy or spondylolisthesis they almost always mean an anterolisthesis which means that the top vertebra has move forward compared to the one below it.  (1)

Q: How did I get it?

A: There are many different reasons why someone might get a spondylolisthesis ranging from trauma to degeneration.  (1)

Q: Is it dangerous?

A: No and yes, it depends on the degree to which your vertebra has slipped and why.  If the slippage is due to trauma it will be unstable while healing but once healed it should be stable and not dangerous.  Spondys are graded on a scale 1 through 5 (See spondylolisthesis grading picture above).  If your spondy is a grade 1 vs. a grade 5 there is a big difference in how dangerous it is.  A grade 5 spondy needs a surgical consult whereas a grade 1 is likely very stable if the bone is intact.

Q: Will I become paralyzed?

A: Very unlikely.  Most people with spondylolisthesis don’t even know they have it.  In fact, people with spondys are less likely to get nerve problems than the average person because they actually have a bigger spinal canal leaving more space for the nerves. (1)  However, if it is from a new traumatic event like a bad car accident it could cause paralysis.  In these rare traumatic cases you are going to have a good clue to be very careful with your body and most likely someone has already called 911 for you and you are on a stretcher with EMTs looking after you.

Q: What side effects should I expect?

A: There can be an altered walking pattern which might cause problems in other joints like your ankles or knees.  Many people think that low back pain shouldn’t be attributed to the spondylolisthesis since the pain can be attributed to other biomechanical problems. (2)

Q: Will it get worse?

A: If you are done with bone growth, 18 year old or so, and the problem isn’t from a disease like Paget’s then it shouldn’t get worse.

Q: Should I restrict activity?

A: This is a hard question to answer because most people discover that they have a spondy when they get pain and while addressing the pain you are going to want to restrict some activities, particularly the actions which set off the pain in the first place.  Once healed, you aren’t going to need to restrict activities, just like most injuries.

Children, however, are a different case.  Most people get their spondy when they are young but it isn’t discovered until they grow up.  When it is discovered in a child most health care professionals will restrict certain activities such as lumbar hyperextension seen in gymnastics (example in blog banner) and repetitive traumatic behavior seen in football.  Some practitioners will even limit unilateral rotational movements seen in bowling, ultimate Frisbee, golf etc…  These restrictions are not necessary if the spondylolisthesis isn’t “active”.  There is a special scan to find out this information, it is called a SPEC.  A SPEC lets your practitioner know if the bone is under active remolding or if it is an old problem that has already resolved.  (1)

 

Q: Can I still exercise?

A: Yes!  Please exercise, but be smart about it.  Strengthen your core in a meaningful way.  I’m not asking that you do 100 sit-ups a day, I’m asking you to work on all the muscles that support the spine.  Make sure you are doing ones that stabilize and not just ones that will give you a six pack.  If you are younger consider avoiding hyperextension activities.

Q: Is there a “cure/ treatment?”

A: Again it depends on how bad the problem is and where it is in stages of healing.  If it is healed you don’t need to do anything.  If it is a new injury from trauma you will need to immobilize it or there might be the need for surgery. (3)  If you are a child and a SPEC scan shows active bone remodeling you should consider getting a Boston overlap antilordotic brace. (4)

Q: Should I be taking medicine or avoiding medicines?

A: There is no need for medicine just because you have a spondylolisthesis unless you have an injury and then all of the same medications that one might take for an injury apply.  Some people might find a time when they need muscle relaxants or pain killers but in general there is no medication that is specific for a spondy.  It has been found that people that with a low back injury that also have spondylolisthesis respond more quickly to chiropractic care than people just suffering from low back pain. (5)  So chiropractic care is a good option for those with low back pain complicated by spondylolithesis.

Q: Should I see a doctor regularly?  If so, how often?

A: Only as much as you would for regular wellness checks if you are not in pain.

Q: Is chiropractic safe?

A: Yes!  Chiropractors help with spinal alignment.  Chiropractic care can be helpful for patients with spinal problems such as a spondylolisthesis.  Often times chiropractors are the ones that discover you have a spondy in the first place.  Chiropractic care usually consists of making sure that the joints around the spondy are moving well but not adjusting the spondy itself. (6)

Q: Is there a way to improve my condition?

A: Make sure you are stabilizing and balancing your core muscles.  Also work on your posture because it will help your spine’s overall health.

Q: What doctor is responsible for naming this because I can’t even pronounce my own condition?

A: It is actually a descriptive name.  Spondylos = vertebra and lithesis = slippage and displacement (1)

 

Trivia: What does a scottie dog have to do with spondylolithesis?

A: When looking for a spondylolithesis, your practitioner will take different x-ray views of your spine.  One view will be the side view seen at the top of the blog.  The other view is a oblique view seen below.  In this view your doctor is looking to see if your vertebra look like scottie dogs with or without a collar.  If the vertebra looks like a scottie dog with a collar you have malunion of bone in your spine which is indicative of a spondy.

1) Yochum, T. and Rowe, L; Yochum and Rowe’s Essentials of Skeletal Radiology (3^rd ed).  2005.

2) Nachemson A: Lumbar spine instability – A critical update and symposium summary. Spine 10:290, 1985.

3) Moe JH, Winter RB, Bradford DS, Lonstein JE: Scoliosis and other Spinal Deformities. Phadelphia, WB Saunders, 1978.

4) Steiner ME, Micheli LJ: Treatment of symptomatic spondylolysis and spondylolisthesis with the modified Boston brace. Spine 10:937, 1985.

5) Mierau D, Cassidy JD, McGregor M, et al.: Comparison of effectiveness of spinal manipulative therapy for low back pain patients with and without spondylolisthesis. J Manipulative Physiol Ther 10:49, 1987

6) Illi FW: The Vertebral Column: Lifeline of the Body. Chicago: National College of Chiropractic, 1951