Spondylolisthesis

What Causes Spondylolisthesis?

Spondylolisthesis occurs when one vertebra moves relative to the vertebra below it. The most common form involves the upper vertebra moving forward, typically referred to as spondylolisthesis.

The most frequent cause of spondylolisthesis in middle aged adults is degenerative, which results from wear and tear, primarily arthritis of the facet joints.

It involves the erosion of joint surfaces, which leads to joint subluxation and vertebral slippage.

Another common form, isthmic spondylolisthesis, involves a pars defect, often acquired during childhood, where a stress fracture causes a discontinuity in the lamina. This allows the vertebra to slip forward.

Other rare causes include trauma, tumours, inflammatory diseases like rheumatoid arthritis, and infections.

Symptoms of Spondylolisthesis

Spondylolisthesis can be asymptomatic or associated with mechanical back pain.

In cases where there is nerve involvement, patients may experience sciatica or neurogenic claudication.

The most affected level in degenerative spondylolisthesis is L4-L5 and in isthmic spondylolisthesis it is L5/S1. Patients may present with nerve pain to the lateral calf and foot, which is L5, in both cases.

Diagnosis of Spondylolisthesis

Diagnosis involves an X-ray of the lumbar spine in a standing position to reveal the true extent of slippage.

An MRI is necessary in those patients with nerve symptoms to confirm neurological compression.

Why Have Surgery?

Patients with nerve pain associated with spondylolisthesis generally require surgery as spontaneous improvement is unlikely.

For degenerative spondylolisthesis with nerve symptoms, surgery may involve decompression or decompression with fixation and fusion. The choice of procedure is based on the degree of slip and presence of mechanical instability. The degree of slippage is categorized into grades (1 to 5), with grade two or higher often requiring fusion surgery.

Isthmic spondylolisthesis always requires fusion as well as decompression.

The Surgical Procedure

The surgical procedure for spondylolisthesis involves making a midline incision to expose the affected levels.

A partial laminectomy will suffice for grade 1 degenerative slips, and for grade 2 or more slips a CT-guided navigation system is used to guide pedicle screw insertion into the vertebrae.

A partial laminectomy is performed to remove the facet joints, allowing for thorough decompression of the nerves. In cases requiring fusion, an interbody spacer and bone graft (from the laminectomy and facet joint removal) are placed in the disc space. Rods are then attached to the screws to stabilize the spine.

The Immediate After Effects of Surgery for Spondylolisthesis

Post-surgery, patients are typically sore for a few days.

They are encouraged to begin walking on the first day after surgery.

Most patients are discharged within five to seven days, and they can walk, shower, and go to the toilet with some assistance needed for daily tasks.

By four to six weeks, patients usually feel significant improvement, but full recovery from a fusion surgery takes about three months.

Post-Surgery Care

Patients return for a wound check at one and a half weeks post-surgery.

Follow-up at six weeks includes an X-ray to check progress. For decompression surgeries, six weeks is often the final checkup.

For fusion patients, additional follow-ups occur at three months, six months, and twelve months, to monitor the development of fusion.

Webinar: SPONDYLOLISTHESIS

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Posted 24 September 2024