Spondylolisthesis (Slipped Vertebrae)

  1. Degenerative Spondylolisthesis: This is the most common type and generally occurs in patients over 50 years of age. It primarily results from the degeneration of the spine, where the facet joint and intervertebral discs cause spinal instability or laxity.
  2. Isthmic Spondylolisthesis: This type is caused by a defect in the pars interarticularis (a part of the vertebral structure), and it usually occurs in younger patients.
  3. Traumatic Spondylolisthesis: This occurs due to an accident or trauma.
  4. Dysplastic Spondylolisthesis: This is caused by abnormal structure of the posterior spinal joint due to congenital anomalies.
  • The severity of back pain can vary from mild to severe and is caused by an unstable joint. 
  • Pain in the back or hip that radiates down the leg due to the narrowing of the spinal canal and nerve compression.
  • Numbness or weakness.
  • Patients may experience pain radiating down the leg after walking a short distance, causing them to take a break (claudication). 
  • Some patients may also experience difficulty controlling urination or defecation.
  1. Plain X-ray, Motion view: Flexion-extension view is used to evaluate spinal instability.
  2. Magnetic Resonance Imaging (MRI): Used to examine the pathology, location, and severity of the nerve compression.
For patients with mild symptoms, treatment may include:
  • Lifestyle modification: Avoiding heavy lifting and maintaining a healthy weight
  • Building strong back/core muscles
  • Medication
  • Physical therapy

For patients with severe symptoms such as severe back pain, severe leg pain, or those who can only walk short distances due to pain, surgery is an effective treatment. There are various surgical options available depending on the patient's needs:
  1. Surgery to insert a spinal implant for stabilizing the unstable spine and removing the tissue and bone that compress the spinal nerve. This is ideal for patients with severe back pain or spinal instability. 
  2. Surgery to remove tissue and bone that compress the spinal nerve. At present, this can be done through a microscope or endoscope, which requires a small incision, results in minor injuries, a short hospital stay, and a fast recovery. This is ideal for patients without back pain or with mild back pain, whose main symptom is leg pain from nerve compression, and who show no spinal instability in the motion x-ray flexion-extension view.

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