What is Spondylolisthesis?

How is Spondylolisthesis Diagnosed?

A spine-trained physician typically diagnoses Spondylolisthesis. Accurate and thorough diagnosis is key to selecting the best treatment options. The following is part of a comprehensive diagnostic workup:

• Medical History Assessment of symptoms, previous treatments and care.
• Physical Examination A careful examination by a spine specialist for limitations of movement, problems with balance, and pain. The examination should also cover loss of reflexes in your extremities, muscle weakness, loss of sensation or signs of spinal cord damage.
• Diagnostic Tests Generally, plain x-ray films are taken which allows the physician to rule out other problems such as infections. CT scans and MRIs are often used to give them a three-dimensional view of the lumbar spine and can help detect herniated discs.

X-rays of your back can show slippage and or fractures of the vertebrae. Also, a MRI and CT scan can pinpoint the damage and help determine the degree of spondylolisthesis and better guide the treatment plan.

Non-Operative Treatment

Most treatment plans start with discontinuing any physical activity that may have caused the condition to happen. Anti-inflammatory medicines such as ibuprofen (Advil) or naproxen (Aleve) are prescribed in order to reduce the inflammation and pain. Physical therapy is also very important to strengthen the core abdominal and low back muscles to provide stability and reduce further damage. When obesity or overweight is the cause of the spondylolisthesis, weight loss may be very helpful.

• Pain Medications anti-inflammatories, muscle relaxers and on rare occasions narcotic painkillers
• Alternating Heat/cold Therapy during the first 24-48 hours
• Physical Therapy exercises to include stretching, massage strengthening
• Epidural steroid injections are used two-fold, first, to relieve inflammation of the affected spinal nerve and secondly, diagnostically to confirm the correct affected level at which the pain originates from.

Least Invasive Procedures

If after 6 months of conservative care and the pain becomes unbearable, and the degree of slippage continues, or if there is compression on the spinal nerves related to the spondylolisthesis, a minimally invasive procedure such as endoscopic foraminalplasty can be helpful.

• Endoscopic ForaminalplastyIn some grade I or II Spondylolisthesis patients, endoscopic foraminalplasty works well. The goal of the surgery is to decompress the foramen (bones around the compressed nerve) and exiting nerve in order to relieve the pressure without destabilizing the facet and thus avoiding a spinal fusion. Unlike traditional spinal fusion surgery, a small 1/2 inch incision is made in the skin. Your muscles are spared and only dilated in order to gain access to the surgical site. The physician uses a working channel endoscope that allows for water and instruments to pass through the scope with a HD camera attached hat provides a superior view of the anatomy and the spinal cord. The patient is under conscious sedation alert and comfortable throughout the procedure. No general anesthesia is needed and thus lower risk to the patient.

Interventional Spine Procedures

• MIS Microdiscectomy Usually an open procedure or using tubular retractor with an incision of 1 inch. The surgeon usually observes through a microscope or set of eyeglass loupes that help magnify the anatomy. Most of the pain, post-operative, is from the approach the surgeon made through muscle in your back. Anesthesia is necessary.
• MIS TLIF The surgery involves removing the damaged intervertebral disc and replacing it with a piece of bone or PEEK cage packed with bone, to assist in union or fusion of the two vertebral bodies over time. Screws are used to hold the disc still until it fuses.

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