Spondolylolithesis can be defined in the simplest way as a medical condition relating to the slippage of the spine, usually anterior (forward) displacement of a vertebra in relation to the vertebrae below. The term Spondolylothesis refers to the condition of a back disorder or spinal instability caused by this slippage. This can lead to a gradual deformity of the lower spine and also a narrowing of the spinal canal that could compress the nerve roots causing pain in the lumbar spine (lower back).
The degree of slippage determines the type of Spondolylolithesis that a patient has and its severity. There are five slip grades of Spondolylolithesis: Grade 1 is < 25%, Grade 2 is 25-50%, Grade 3 is 50-70%, Grade 4 is 75-100% and Grade 5 is the complete dislocation of the spine (spondyloptosis). Grade one is usually the least advanced, and grade 5 is the most advanced form of Spondylolisthesis.
There are a number of causes of Spondolylolithesis that indicates the type of Spondolylolithesis that exists in a patient. The five major types of Spondolylolithesis are Dysplastic or Congenital Spondolylolithesis, Isthmic Spondolylolithesis, Degenerative Spondolylolithesis, Traumatic Spondolylolithesis and Pathological Spondolylolithesis.
Children are also susceptible to having Spondolylolithesis commonly Dysplastic or Congenital (inborn defect of the bone of the spine) and Isthmic Spondolylolithesis (relating to a defect in the par interarticularis, part of the vertebrae that connects the upper and lower facet joints). It is possible that the pars defect would be present without any slippage referred to as spondylolsis. The majority of cases when this type of Spondolylolithesis condition is detected is when a fracture or injury is caused to this part of the vertebrae from repetitive micro fractures from performing certain sports activities such as running, gymnastics, football, weight lifting and or diving.
Adults usually suffer from Degenerative Spondolylolithesis which is the most common form of Spondolylolithesis as it occurs due to aging and the general wear and tear of the tissues, bones, muscles and ligaments in our back or from a rare underlying disease such as arthiritis, osteoporosis, or a tumor or cancer of the spine.
The most severe case of Spondolylolithesis usually occurs due to some major accident, or direct trauma or injury to the spine that results in complete dislocation of the spine leading to Traumatic Spondolylolithesis. The fracture would be associated with the posterior elements such as the pedicle, lamina or facets, other than the pars interarticularis, that allows the front portion of the vertebrae to slip forward in relation to the back portion of the vertebrae to a very high degree (Grade 4 or 5). Traumatic Spondolylolithesis can also occur due to a complication after spinal surgery, in particular a laminectomy or decompression of the spine, however this is very rare.
Surgery would be the only advisable treatment for Traumatic Spondolylolithesis as the back is completely unstable unlike in the other types of Spondolylolithesis. Treatment in order to stabilize the back may include the use of braces in order to help the patient walk, and surgical treatments such as lumbar decompression accompanied by spinal fusion using spinal instrumentation (implants, screws, to help aid the healing process). Surgery can be performed from the posterior (back of the spine) or from the anterior side (front of the spine). Once the surgery is successfully performed the patient may experience pain that may be reoccurring for which doctor’s would recommend taking pain relievers and anti-inflammation medications. Also the patient after having gone through the surgery will have to alter his or her activities so as to not put any pressure on the spine and to avoid further injury.