When is a Spinal Fusion necessary to treat Spondylolisthesis in an adult ?

Spondylolisthesis describes a condition of forward slippage of one vertebrae in the spine over another. This conditions in adults is most commonly due to degeneration (wear and tear) of the discs and ligaments in the spine. Pain is most commonly the single symptom of this condition. Occasionally, numbness, tingling and weakness may also occur, particularly with activities. Sophisticated imaging such as MRI and CT scans will show "stenosis", or a 'pinched nerve in a narrow spinal canal'. One must realize that the imaging studies are obtained when the patient is lying down (supine) on the imaging table. However, most of the symptoms are aggravated by standing, walking and other activities. The treatment for spondylolisthesis must thus aim at not only decompressing the nerve, but more importantly at stabilizing the spine in an optimal position. A conservative treatment can be successful in mild conditions by using a brace and stabilization exercises. When failure of this treatment occurs surgical intervention may be necessary. When instability is significant then stabilization of the spine with a fusion may be essential to relieve pain and disability.

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What causes Spondylolisthesis in children?

In children and teenagers before maturity spondylolisthesis are very often due to a dysplasia of the L5-S1 area of the spine which means that the child was born with a slightly abnormal formation of the anatomical elements of the last lumbar vertebra (called L5) and of the sacrum. In most of the cases this is more a condition than a true problem and if it becomes a problem it is often due to stress and overuse of this area like in practicing gymnastics. This condition may then cause pain and is called "isthmic spondylolisthesis" which is diagnosed by simple X Rays of the lumbo-sacral ( A.P, Lateral and Oblique views) . The child must be evaluated by an orthopaedic spine specialist and if there is no sign of nerve suffering, it very often may be treated by bracing. In rare cases the spondylolisthesis is unstable and involves progressive slippage of the spine with potential hazards for the nerves. In the rare severe and unstable spondylolistheses aggressive treatment may be required. When the conservative treatment has not succeeded, surgery may necessary to stabilize the Lumbo-Sacral area and to correct a kyphosis if there is a significant kyphotic deformity at the Lumbo-Sacral level.

If you are interested in our publication on this subject you may want to read an article in Spine (Vol. 22 No. 14 July 15, 1997).

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Is the back and leg pain related to how much the Spine has slipped
in Spondylolisthesis?

In fact the degree of spine slippage in spondylolisthesis is not directly related to pain. There are many people who have some degree of spondylolisthesis and are not even aware of it. On the other hand some individuals suffer from significant pain despite only minimal slippage of the spine. It seems that pain is more related to the degree of instability (shifting and abnormal amount of motion) as well as the amount of nerve compression, than actual amount of slippage itself.

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Why do my legs hurt more than my back if the problem
with Spondylolisthesis is in the Spine?

The leg pains, cramping and heaviness that are due to spinal stenosis and spondylolisthesis are problems at the level of the spine. However, the brain can not tell exactly at what level nerve compression and dysfunction are occurring. Therefore, although the nerves may be getting into trouble in the spine, your brain may tell you that the area of nerve control (ie. The legs) are getting affected. In some patients there may be minimal or no back pain at all.

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Do all cases of Spondylolisthesis progress?

Not at all. In fact most patients who have a spondylolisthesis do not have any significant progression of spinal slippage. In most cases medication, therapy, and occasionally bracing can offer improvement and marked progression of symptoms is usually not the case. In the few people where symptoms progress and pain or dysfunction becomes severe, some form of intervention may be necessary.

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Is the goal of Spondylolisthesis surgery to correct
the spinal slippage?

If non-operative treatments fail to offer relief, surgery may be an option to consider. The goals of surgery rarely include correcting the slippage itself. In most cases, freeing up the nerves (decompression) and obtaining a stable spinal column (fusion) in good alignment, are the primary goals.

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What is the recovery like after Spondylolisthesis surgery?

Every patient is different and so it is difficult to generalize. However, most patients appear to spend about 3-5 days in the hospital and then spend some time on a rehabilitation service (1-2 weeks) prior to going home. The initial pain from surgery improves rapidly during the first days. The symptoms of leg pains and heaviness tend to improve gradually over weeks.

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