Isthmic spondylolisthesis

By Sally Ann Quirke, Chartered Physiotherapist | Filed under: Spondylolisthesis

Published: 04 December 2015

Spondylolisthesis - the name sounds exotic, but in fact it is quite a common problem that I treat clients for!

What is Spondylolisthesis

When one vertebra moves forwards out of that alignment it is referred to as spondylolisthesis - “spondylo” meaning spine and “listhesis” meaning slippage. It can be caused by a number of things. The ithmic part tells us what type of spondylolisthesis it is - here, it involves the pars interarticularis which is a small thin ‘isthmus’ of bone that connects superior and inferior facets in a vertebra. If this fractures or has a defect, it can cause one the vertebra to slips forwards on another.

Although this can occur at most locations along the spine, it is most commonly occurs in the L5 vertebra, which is the last lumbar vertebra in your spine (situated around the level of your pelvis). Read more about the anatomy of the spine

There are various severities of slippage found in clients with spondylolisthesis. I, amongst many other healthcare professionals, grade them on a grade 1 - grade 5 scale. This is normally determined by an x-ray, followed by an MRI scan of your back.

• Grade 1 - is where there is a small slippage forwards of a bony vertebrae, usually about 25%.
• Grade 2 -between 25% and a 50% slippage
• Grade 3 - from 50% up to 75%
• Grade 4 - from 75% up to 100% slippage
• Grade 5 - vertebra has fallen off the edge!!

The most common grade that I encounter on a weekly basis is a grade 1 or 2.

There are two kinds of spondylolisthesis:

1. Congenital - where you are born with a degree of slippage of a vertebra. This usually occurs in the lower back and often is not discovered until you are in your teens or twenties. It may never display symptoms.

2. Acquired - is where you develop a slippage either traumatically from falling, or from repetitive strenuous exercise resulting in a fracture and slippage.

Symptoms of spondylolisthesis:

Your symptoms can vary greatly, from no pain at all to severe pain. It depends on the severity and extent of your slippage, as well as your posture type and what activities or movement pattens you have been doing. Common symptoms include

• Lower Back Pain, sometimes associated with bending over or twisting or rotating your back.
• Buttock pain, again sometimes where you twist or bend over.
• A sciatic type pain that runs from the lower back down one or both legs.
• Pins and needles, numbness or weakness in one or both legs.
• In severe cases, symptoms can include difficulty in walking or even urinary or incontinence problems.

Quite often clients have come to me with spondylolisthesis and their symptoms have not been coming from the slippage at all. Their symptoms have been coming from joints and muscles above and below the slipped vertebra. In these cases, we have often resolved their symptoms completely, although their slippage is still there!!

Spondylolisthesis Treatment:

The treatment of spondylolisthesis will depend on the severity of the slippage, the symptoms you are experiencing and the nature and level of activity in your daily life.

Where the severity of the spondylolisthesis is mild (grade 1 or 2 usually), quite often conservative manual treatments specific to your condition will resolve your symptoms fully. Treatment usually involves mobilising the stiffened segments above and below your vertebral slippage, followed by an intense stability exercise programme. In more severe cases, surgery can be necessary where slippage is large and symptoms severe.

The most important aspect of conservative treatment is that the therapist treating you has a good understanding of your condition, as exercises must be very specific in direction and range. A good chartered physiotherapist should help you. I use an adapted Pilates programme - “adapted” being the key word.

So I hope you found this article useful.

Best wishes,

Sally Ann.