SPONDYLOLISTHESIS

SPONDYLOLISTHESIS IN INDIA

What Is Spondylolisthesis?

Spondylolisthesis [ spon + dee + lo + lis + thee + sis ] is a condition of the spine whereby one of the vertebra slips forward or backward compared to the next vertebra. Forward slippage of one vertebra on another is referred to as anterolisthesis, while backward slippage is referred to as retrolisthesis. Spondylolisthesis can lead to a deformity of the spine as well as a narrowing of the spinal canal (central spinal stenosis) or compression of the exiting nerve roots (foraminal stenosis).

There are five major types of lumbar spondylolisthesis : –

1. Dysplastic spondylolisthesis : – Dysplastic spondylolisthesis is caused by a defect in the formation of part of the vertebra called the facet that allows it to slip forward. This is a condition that a patient is born with (congenital).

1. Isthmic spondylolisthesis : – In Isthmic spondylolisthesis, there is a defect in a portion of the vertebra called the pars interarticularis. If there is a defect without a slip, the patient has spondylolysis. Isthmic spondylolisthesis can be caused by repetitive trauma and is more common in athletes exposed to hyperextension motions including gymnasts, and football linemen.

1. Degenerative spondylolisthesis : – Degenerative spondylolisthesis occurs due to arthritic changes in the joints of the vertebrae due to cartilage degeneration. Degenerative spondylolisthesis is more common in older patients.

1. Traumatic spondylolisthesis : – Traumatic spondylolisthesis is due to direct trauma or injury to the vertebrae. This can be caused by a fracture of the pedicle, lamina or facet joints that allows the front portion of the vertebra to slip forward with respect to the back portion of the vertebra.

1. Pathologic spondylolisthesis : – Pathologic spondylolisthesis is caused by a defect in the bone caused by abnormal bone, such as from a tumor.

Spondylolisthesis may vary from mild to severe. A person with spondylolisthesis may have no symptoms.

The condition can produce increased lordosis (also called swayback), but in later stages may result in kyphosis (roundback) as the upper spine falls off the lower spine.

Symptoms may include: –

• Lower back pain
• Muscle tightness (tight hamstring muscle)
• Pain in the thighs and buttocks
• Stiffness
• Tenderness in the area of the slipped disc

Nerve damage (leg weakness or changes in sensation) may result from pressure on nerve roots and may cause pain radiating down the legs.

Possible Complications

• Chronic back pain
• Nerve compression
• Temporary or permanent damage of spinal nerve roots, which may cause sensation changes, weakness, or paralysis of the legs

Treatment in India

Treatment varies depending on the severity of the condition. Most patients get better with strengthening and stretching exercises combined with activity modification, which involves avoiding hyperextension of the back and contact sports.

Some health care providers also recommend a rigid back brace.

Surgery to fuse the slipped disc may be needed if you have severe pain that does not get better with treatment, a severe slip of the vertebra, or any neurological changes. Such surgery has a higher rate of nerve injury than most other spinal fusion surgeries. A brace or body cast may be used after surgery.

Prevention in India

People with marked lordosis should avoid back hyperextension (leaning way back), weight lifting, and contact sports.

Lower back pain, although common in preadolescent and adolescent children, should be evaluated, especially in the presence of marked lordosis.

Unnecessary Spondylolisthesis Surgery in India

Many patients with mild to moderate spondylolisthesis have endured unnecessary back surgery to correct an asymptomatic variety of the condition. Mild to moderate cases rarely cause pain or related symptoms and often act as a convincing back pain scapegoat on which to blame pain from a completely different causation. Before undergoing any surgical procedure for your unresolved back pain caused by spondylolisthesis, try knowledge therapy to eliminate the chances that your pain is due to a psycho-emotional source, rather than a anatomical cause. In addition, be sure to exhaust every possible conservative therapy modality prior to undertaking any invasive treatment option.