The spinal column is comprised of vertebral bodies stacked on top of each other. A condition in which one vertebral body is slipped forward (or backward) relative to the adjacent vertebrae is called Spondylolisthesis. This misalignment can result in segmental instability, changes in motion biomechanics and nerve (or spinal cord) entrapment, all of which can result in localized back pain , radicular pain (also known as sciatica) and weakness. This condition is most common in the lower back region but is also found in neck and mid back.
There are different types of spondylolisthesis. Some patient are born with it and are unaware of it. Some acquire it as result of arthritic changes of the facet joints or underlying trauma leading to segmental instability (like Pars fracture in child gymnast).
At Tufts Medical Center in downtown Boston, we begin treatment of spondylolisthesis by getting a thorough understanding of a person’s medical history and undergoing a clinical exam. Spondylolisthesis is most often an incidental finding on lower back x-rays. It is graded 1-5 depending on the degree of slippage. Dynamic X-rays, Bone scan, CT scan and MRI will help define the stability, acuity and severity of the Spondylolisthesis and degree of nerve root impingement
If symptomatic, the most common complaint in patients with spondylolisthesis is back pain with or without leg pain (or neck pain with or without arm pain). In addition to spinal pain , there can be associated muscle spasms, numbness and tingling of the leg or arm and even weakness.
Activity modification is a recommendation for painful spondylolisthesis. A back brace is offered for those with higher gradations of slippage, pediatric population with acute trauma or for comfort. Pain relief can be achieved by means of over-the-counter anti-inflammatory medications, prescribed pain medications, muscle relaxants and topical medications, Physical therapy can provide stabilizing exercises, but can take 8-12 weeks to reach maximal improvement. Minimally invasive spinal procedures can be safe and effective method of controlling pain . This includes facet injection or Radiofrequency Ablation for back pain or Epidural steroid injections for leg pain. In selected cases , pars interarticularis injection can be tried for pain relief.
For patients with unstable spondylolisthesis or for those with persistent pain and functional impairment despite conservative care, Spinal Fusion Surgery should be considered .
Programs + Services
The Tufts MC Pain Management Center in downtown Boston specializes in eliminating or reducing chronic pain (particularly in the back and neck) and cancer pain.
The Tufts MC Spine Surgery Program in Boston provides a range of diagnostic and therapeutic services for spinal disorders, such as herniated discs and spinal tumors.
The Spine Clinic at Tufts Medical Center in Boston provides alternatives to back surgery, such as bracing, exercise, physical therapy, medication and precisely guided injection therapy.