SPONDYLOLISTHESIS

• Degenerative spondylolisthesis, as noted above, is caused by spinal osteoarthritis, also known as spondylosis, in which facet joints and discs of the spine deteriorate over time. This is the most common form on spondylolisthesis

• Isthmic spondylolisthesis is caused by a pars interarticularis defect, also known as a pars fracture or spondylolysis. The crack of a pars fracture affecting both sides of the connection between the lamina and pedicles leads to slippage of the vertebrae.

• Congenital or dysplastic spondylolisthesis is a birth defect in which there is a growth abnormality of the spine.

• Traumatic spondylolisthesis is where a trauma to the spine forces vertebrae out of alignment.

• Pathologic spondylolisthesis is caused by a separate bone disease, such as a spinal tumor or osteoporosis.

• Iatrogenic (postsurgical) spondylolisthesis is caused by spinal destabilization resulting from a prior spinal decompression surgery without instrumentation.

If your doctor thinks you might have this condition, they'll ask about your symptoms and run imaging tests to see if a vertebra is out of place. These tests may include:

• X-ray

• CT scan

• MRI scan

The treatment you'll need depends on what grade of spondylolisthesis you have, as well as your age, symptoms, and your medical history. Low grade can usually be treated with physical therapy or medications. With high grade, you may need surgery, especially if you're in a lot of pain.

Nonsurgical treatment options include:

• Rest: You may need to take some time off from sports and other vigorous activities.

• Medications: Your doctor may recommend over-the-counter anti-inflammatory medicines to relieve your pain, such as ibuprofen or naproxen.

• Injections: Steroid shots in the area where you have pain can bring relief.

• Physical therapy: Daily exercises that stretch and strengthen your supportive abdominal and lower back muscles can lower your pain.

• Braces: For children with fractures in the vertebrae (spondylolysis), a back brace can restrict movement so the fractures can heal.

If you have high-grade spondylolisthesis or if you still have serious pain and disability after nonsurgical treatments, you may need surgery. This usually means spinal decompression, often along with spinal fusion.

• Spinal decompression: Decompression lessens the pressure on the nerves in your spine to relieve pain. There are several techniques your surgeon can use to give your nerves more room. They may remove bone from your spine, take out part or all a disc, or make the opening in your spinal canal larger. Your surgeon might need to use all these methods during your surgery.

• Spinal fusion: In spinal fusion, fusing, the affected vertebrae together to prevent them from slipping again. After this surgery, you may have a bit less flexibility in your spine.

• Pars repair: This surgery repairs fractures in the vertebrae using small wires or screws. Sometimes, a bone graft is used to reinforce the fracture so it can heal better.