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Spondylolisthesis
Spondylolisthesis often occurs in the L4,5 area. Patients may experience pain and numbness in the lower back. If spinal nerve roots are compressed, in addition to feeling pain, it will cause lower limb numb and weak. In severe cases, it may cause urination incontinence.
Spondylolisthesis refers to the slippage of the bones in your spine (Refer to Figure 1). This disease is mainly due to structural problems of the Pars Interarticularis- the bony connection between the facets. As seen on figure 2, the connection of the joint has fractured and slipped. This may occur on both sides of the vertebral condyle or only one side of the spine. In most cases, the patient does not feel pain unless the slippage is severe enough to suppress the nerve. Doctors often find that the patients have spondylolisthesis through X-rays.
Figure 2: The connection between facets- Pars Interarticularis has fractured and slipped.
Case sharing
In October 2018, 55-year-old Miss Lin suffered from long-term low back pain, foot pain. The pain slowly intensified, she felt pain in the lower back when coughing or sneezing, as well as in her feet, legs and knees, which eventually she felt pain when sitting, or walking. As Miss Lin recalled her conditions, she discovered that she began to suffer from lower back pain after a ski accident 20 years ago. For many years, she relieved pain through massage and acupuncture. Due to recent coughing and sneezing that triggered the pain, she reasoned that the condition of her spine is getting worse. After magnetic resonance imaging examination, it can be observed that the patient has severe spondylolisthesis in L4,5, which results in compression of the cord (As seen in Figure 3). She was then referred to a neurosurgeon for a lumbar fusion surgery by the author (As seen in Figure 4). After the operation, the patient’s symptoms of lower back pain and referral pain were improved. Ms. Lin now continues to strengthen her lower back muscles by swimming and doing light stretching exercises, while receiving post surgical chiropractic treatment every month.
Figure 3: Through MRI, it can be seen there is severe slippage of L4,5 of spine resulting compression on the central nerve line.
Figure 4: Lumbar Fusion surgery
Spondylolisthesis type
Dysplastic-Caused by a congenital defect (present from birth) in the L5 area, causing the facet joints to slip and slide in the future.
Traumatic-Fracture of the spine due to accidental trauma, resulting in the condition of spondylolisthesis in the future.
Degenerative-Degeneration of the spine causes slip and slide between joints of the spine, gradually forming spondylolisthesis. Some studies have pointed out that women aged 60 and above are diagnosed with degenerative spondylolisthesis in L4, 6times more than men.
Pathological- Caused by a certain kind of bone disease such as bone cancer, osteoporosis, and Bodhi’s disease, etc., resulting in spondylolisthesis.
Most patients are asymptomatic
Generally, patients with spondylolisthesis do not have symptoms. When patients having lower back pain, an X-ray examination will be ordered for diagnosis. Potential conditions include fractured joints resulting slip and slide, prolonged spine degeneration resulting spondylolisthesis. When conditions of spondylolisthesis are severe, the cauda equina nerve may be compressed, which causes lack of strength in the lower body, sometimes affects urinary dysfunction ect,. Symptoms such as stiffness in the lower back when carrying heavy loads or long term bending and sitting.
Additionally, when suffering from lumbar spinal stenosis, intermittent claudication causes the inability for the patient to walk. If the symptoms continue to be worsen, patients should consider surgery.
