Spondylolisthesis and Chiropractic
We are often asked by patients who have been diagnosed with a spondylolisthesis (Spondy) if chiropractic care can help them. The answer is that there is often a lot we can do to help.
Spondylolisthesis is a common condition we see many times a week in our clinic and this blog will explain all you need to know about the distinct types of spondy, what causes them and how we can help you.
What is Spondylolisthesis
Spondylolisthesis refers to the forward slippage of one vertebra in relation to the segment immediately below it.
This condition occurs when there is a fracture or malformation of a specific part of your vertebra called the Pars interarticularis (pars). In this condition the two sides of the fracture site separate which allows the vertebra to slip forward as shown in the diagram below.
(Left) The pars is a narrow bridge of bone found in the back portion of the vertebra. (Center) Spondylolysis occurs when a fracture of the pars occurs. (Right) Spondylolisthesis occurs when the vertebra shifts forward due to instability from the pars fracture.
Chiropractic and spondylothesis
As chiropractors, we take a holistic approach to improving the symptoms associated with a spondylothesis. Our aim is to get you as pain-free as possible and keep you that way in the future.
We achieve this by improving the functioning of all your spine, not just the area of where the spondylolisthesis is. It is just as important for us to ensure the segments surrounding the spondy are balanced and moving freely to maintain function and minimise your pain in the area. At the same time, we will give you specific exercises to improve the flexibility, strength, and coordination of your spine.
Clinically, we find this approach gives patients both excellent pain relief and helps to keep them as healthy and functional as possible.
What causes spondylolisthesis?
There are three main types of spondylolistheses and whilst the causes of each one is different, they are sometimes interrelated.
Degenerative is the most common type of spondylolisthesis we see and it responds very well to chiropractic care. It is more common after the age of 50 as a result of wear and tear of the spine with aging, most commonly picked up on Xray as an incidental finding with most patients not knowing they had a spondy in the first place.
Occurring more commonly in women than men, it is also associated with obesity and smoking. There is no known reason why some patients with spinal wear and tear develop spondylolisthesis while others do not.
In congenital spondy the spine does not form correctly before birth. Research indicates the pars interarticularis in some people is thinner and more prone to injury when placed under weightbearing stress. These thinner areas are believed to have a large genetic component in their origin as it can be seen through generations of relatives.
Isthmis spondy occurs due to overuse of the spine and in most cases involves young athletes developing a stress fracture of the pars interarticularis. This is caused by repetitive flexion, hyperextension, and rotation of their spine and usually occurs in sports such as cricket, gymnastics, dancing or weightlifting. Occurring more often in males, it has been estimated to affect about 5 to 7% of the population.
Symptoms of spondylothesis
The symptoms related to a spondy will vary dramatically from patient to patient, and generally depend on the severity of slippage and what patients are doing day to day to put load on the lower back. Some patients have no symptoms from their spondylolisthesis at all while others can have symptoms ranging from mild low back pain and stiffness to severe debilitating symptoms in their back and legs.
The most common symptoms of spondylothesis are: –
- Localized low back pain that comes and goes
- Pain radiating to the buttocks and back of the thighs
- Tight low back and leg muscles
- Pain that is worse with activity and improves with rest
- Difficulty with prolonged standing and walking
Severe symptoms of spondylothesis are: –
- Nerve entrapment causing weakness, numbness and/or tingling in one or both legs
- Debilitating pain
- Severe Walking difficulties
- Loss of bowel or bladder control
How is a spondylolisthesis diagnosed?
Spondylothesis is diagnosed by X-ray, Computed Tomography (CT) Scans and Magnetic Resonance Imaging (MRI) Scans.
How is a spondylolisthesis measured?
A spondylothesis is graded by how far forward the vertebra has has slipped on top of the segment below on an Xray. Grade I spondylolisthesis is up to 25% slippage, grade II is between 25 and 50% slippage, grade III is between a 50 and 75% slippage, and grade IV is between 75 and 100% slippage.
Grade I spondylolisthesis is the most common and accounts for 75% of all cases.
Where does spondylothesis occur
Spondylolisthesis occurs about 90% of the time in the low back between the fifth lumbar vertebra and the sacrum. The second most common location is between the fourth and fifth lumbar vertebra. It can also occur in the neck however this usually only associated with spinal degeneration or trauma.
Can spondylolisthesis be reversed?
No A spondylolisthesis can’t be reversed except by surgery and this is only used in the most severe cases when non-surgical methods have failed or when there is severe neurological complications present.
Treatment of spondylolisthesis
The treatment of spondylolisthesis will vary depending on the type of spondylolisthesis that is present.
Degenerative and congenital spondylolisthesis are the most common types of spondylothesis that we see in our clinic and respond very well with chiropractic care. Our goals are to reduce pain and inflammation in region by improving spinal function and reducing muscle tightness. It is important to strengthen and re-coordinate the deep support muscles of the lumbar spine at the same time.
This is achieved by a combination of: –
- Chiropractic and/or physiotherapy to restore spinal function and increase spinal flexibility
- Individualized exercise programs to strengthen and stabilize the main muscles of the spine
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen if necessary
With Isthmic spondylolisthesis the treatment goals are more to reduce pain and allow a recent pars fracture to heal.
This is achieved by a combination of: –
- rest and avoiding activities that place excessive stress on the lower back
- Chiropractic and physiotherapy to improve flexibility and strengthen muscles in the back and abdomen.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
- a back brace to promote healing of the damaged area
Treatment of spondylolisthesis – Surgical
Surgery may be necessary for spondylolisthesis patients who have symptoms from a severe or high-grade slippage that is progressively worsening and nonsurgical treatment has failed.
Spinal fusion is the surgical procedure most often used and aims to stabilize the spine and reduce pain. The basic idea is to fuse together the vertebrae so that they heal into a single, solid bone.
What happens if Spondylolisthesis is left untreated?
In most patients the likelihood of significant progressive slippages of the vertebra is low. Patients under 10 years of age have a higher risk for progression of spondylolisthesis as their spine is still develpoing and maturing.
How to manage Spondylolisthesis at home
- Have regular chiropractic care to ensure your spine working as well as possible
- Improve muscle strength and balance through stretching and exercise
- Use a good supportive mattress
- Have good ergonomics in your workplace and home
- Maintain a healthy weight
With good conservative care the majority of patients with spondylolisthesis can be free from pain and other symptoms.
Is spondylolisthesis the same as spondylolysis?
Spondylolysis and spondylolisthesis are different spinal conditions which are often related to each other. Spondylolysis is a stress fracture of the pars interarticularis without slippage of the vertebra. It is explained fully in this blog about spondylolysis.
If you have been diagnosed with spondylolysis, call us or book an appointment online to see if we can help you.
Common Conditions That Chiropractic Can Help