Pain caused by injuries to vertebral bones can be severe and long-lasting. For many it’s a kind of pain that places significant limits on a person’s ability to enjoy life. Daily activities once taken for granted are now a struggle, if not impossible, to complete due to chronic, severe pain.
One conditions people with vertebral injuries experience is called spondylolisthesis. Pain specialist Dr. Robert Nocerini has experience treating patients across Dallas at his office in North Dallas.
Dr. Nocerini sheds some light on what spondylolisthesis is, how it occurs and what treatment options are available to chronic pain patients in Dallas, TX.
Question: What is Spondylolisthesis?
Dr. Nocerini: “Spondylolisthesis is a condition in the spine in which one vertebral bone slips forward relative to the one beneath it. The degree to which it slips forward is graded on a scale of 1 to 5, with lower grades representing mild cases, and higher grades representing more severe cases.”
Question: What are vertebrae or vertebral bodies?
Dr. Nocerini: “The typical human spine is made up of a series of bones called vertebrae, or vertebral bodies. From top to bottom, there are 7 cervical vertebrae in the neck, 12 thoracic vertebrae in the upper back, 5 lumbar vertebrae in the lower back, 5 sacral segments fused into one sacrum, and 4-5 small bones that make up the coccyx. In a spine with normal alignment, each vertebral body is centered on the one beneath it, with an intervertebral disc separating the two bones.”
Q: Where does spondylolisthesis occur?
Dr. Nocerini: “Spondylolisthesis commonly occurs in the lower lumbar spine, usually at the L5/S1 disc space where the lumbar spine meets the sacrum, but it may also occur at L4/5 or other levels.”
Q: What are the different types of spondylolisthesis?
Dr. Nocerini: “The most common types of spondylolisthesis are isthmic and degenerative.
Isthmic Spondylolisthesis tends to develop in childhood or as a teen in around 6% of the population. It is caused by a fracture in part of the vertebral body called the pars interarticularis, which is part of the neural arch of the spine. This section protects the spinal cord and the spinal nerve roots as they come off the spinal cord. The term for this type of fracture is “spondylolysis,” also called a “pars fracture.” The terms can start to sound alike, as there is also a very common spinal condition called “spondylosis,” which is degenerative osteoarthritis in the spine. A pars fracture may occur from participating in sports that require extreme back bending or from heavy lifting, so participants in gymnastics, diving, football, and wrestling have a higher risk of developing spondylolisthesis than the general population.
Degenerative Spondylolisthesis tends to develop in the sixth or seventh decade of life. This occurs due to degeneration of the small joints in the back of the spine called the facet joints, and weakening of the spinal ligaments, which help hold the spine in alignment. “
Q: Is spondylolisthesis always painful?
Dr. Nocerini: “Many people do not have any symptoms from spondylolisthesis. Others may have low back pain, which increases when leaning back, and they may have tight hamstring muscles and thigh pain.”
Q: How does spondylolisthesis cause pain?
Dr. Nocerini: “Spondylolisthesis may cause pain by affecting the spinal nerve roots. When one vertebral body slides forward on top of another, it causes a narrowing of the spaces on the sides of the spine through which the spinal nerves travel. These spaces are called neural foramen, and the narrowing is called neural foraminal stenosis. This pain may be felt in the back and radiate down one or both legs. Spondylolisthesis may also cause pain by creating traction on the intervertebral disc below the vertebral bone that is slipping forward. As the spine slips forward on top of the disc below it, the increase in shear force may cause degeneration of the disc and disc pain. Also, enlarging facet joints can encroach on the spinal canal causing symptoms similar to spinal stenosis, such as leg pain.”
Q: How do you diagnose spondylolisthesis?
Dr. Nocerini: Radiological evaluation of spondylolisthesis usually starts with plain x-rays. Evaluation might include standing x-rays, as spondylolisthesis might resolve when lying down for imaging. Flexion/extension x-rays may also be indicated to determine if the vertebral bodies shift position with movement, indicating an unstable spine. A CT scan may give more information about a pars fracture, and an MRI may help to diagnose any nerve root impingement, stenosis, or disc abnormalities.
Q: How is spondylolisthesis treated?
Dr. Nocerini: “In mild cases, pain medication and physical therapy may be helpful. Physical therapy generally consists of exercises that strengthen the muscles that make up the “core,” or the muscles that support the spine, such as the back muscles, abdominal, and oblique muscles. In cases where conservative measures such as these are not helpful, epidural steroid injections may be helpful, specifically targeting the nerve roots that are being compressed by the slipping vertebral body, facet joints or disc. In severe cases where medications, physical therapy, and injections are not helpful, surgery may be indicated to align the spine.”
Q: Can I still be active if I have Spondylolisthesis?
Dr. Nocerini: “In most cases of spondylolisthesis, individuals may still participate in sports and physical activity. Each case is individual, however, and the decision to participate in physical activity, along with the degree of participation, should be guided by a qualified medical provider.”
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