A Spondylolisthesis is a condition most commonly of the lumbar spine. It occurs when there is a stress fracture, known as a spondylolysis in the vertebra. This fracture can result in the forward slippage of the vertebra and once this has occurred, it is known as a Spondylolisthesis.
Approximately 5% of the population have this condition, with males being twice as likely as females to develop the condition. An estimated 50% of people with a Spondylolisthesis do not develop pain, while others, usually sportsmen/women are likely to suffer pain and discomfort.
90% of Spondylolisthesis with an anterior slippage of the vertebrae occurs at the level of L5. This is the lowest lumbar vertebra, which meets the sacrum and thus can be the reason for low back pain among active people. They can be stable or unstable depending on the persons activity levels.
Spondylolisthesis are graded depending on the amount of forward slippage of the vertebra. Grade 1 indicates minimal forward movement, while grade 4 is the maximal anterior slippage. All of these grades can also be classified as stable or unstable depending of the surrounding tissues.
There are 5 different classifications of Spondylolisthesis:
1. Dysplastic: a congenital abnormality in the vertebrae causing the slip
2. Isthmic: fracture of the ‘pars-interarticularis’ part of the vertebra caused by stress or trauma
3. Degenerative: secondary to long term degenerative change
5. Pathological: in conjunction with bone disease
Isthmic is the most common type with the stress fracture in the vertebra occurring at a young age. This is most commonly due to repetitive stress from high amounts of activity. Sports such as gymnastics, which requires repetitive hyperextension, are more likely to cause problems. Most of the slippage occurs before the age of 10 and is not likely to progress after this age. The goal with a young person suffering from this is to create stability with specific adjustments and a corrective exercise program.
Degenerative Spondylolisthesis are the second most common and occurs more often in the elderly. Grade 1 and 2 degenerative Spondylolsthesises are often classified as stable and pain free, while grade 3 and 4 may require surgical consultation depending on the severity of the symptoms.
How is it diagnosed?
Your Chiropractor will begin by taking a history and performing a physical examination. A palpable step or depression may be present to indicate the likelihood of a spondylolisthesis. X-rays may then be ordered of your back and if further investigation is needed CT or MRI are far more sensitive at detecting any signs of a spondylolisthesis. Occasionally nearby discs can suffer wear and tear from the mechanical stresses of this condition; so advanced imaging can help with diagnosis of these.
The main goals when treating spondylolisthesis are to optimise good spinal mechanics and to improve posture and alignment. Chiropractors do not reduce the slippage, instead, we address the spinal joints above and below the slipped vertebra—helping to address the mechanical and neurological causes of spondylolisthesis. This can help relieve low back pain and improve motion in the region.
If you would like more information or would like to book an appointment at Neurohealth Chiropractic – please call the clinic on 9905 9099 or email us firstname.lastname@example.org or fill in the contact form from our website www.neurohealthchiro.com.au
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