Common Spondylolithesis Questions

What is spondylolisthesis?
A spondylolisthesis is a forward slip of one vertebra over the one beneath it. Spondylolisthesis occurs most often in the lumbar (low back) spine. There are several types of spondylolisthesis, such as congenital, developmental, and acquired. Congenital spondylolisthesis means it is present at birth. Developmental may develop during childhood, but is usually not noticed until later in life (adulthood). Acquired spondylolisthesis is caused by stresses exerted on the spine such as during weight-lifting, gymnastics, carrying heavy items, or trauma. Degeneration of spinal anatomy may cause ligaments to weaken allowing a vertebra to slip forward.

What causes spondylolisthesis?
Some people are born with a thin vertebral bone called the pars articularis, which, from the side resembles a Scotty dog. Force or stress, such as during a growth spurt or from trauma, may contribute to this bone breaking causing the vertebra to slip forward. Overuse is another cause. Sports such as gymnastics and football stress the lower back.

How is spondylolisthesis treated?
Non-surgical treatment may include activity restriction, medication to reduce inflammation and pain, a brace to support the spine, spinal injections, and physical therapy.

Will I need surgery to fix my spondylolisthesis?
That depends on many issues including the severity of the spondylolisthesis, if serious neurological symptoms exist (bowel/bladder dysfunction), and the success (or failure) of non-surgical care.

Surgery aims to remove pressure on spinal nerves (called decompression) and stabilize the spine. Usually, low back decompression is combined with spinal fusion and instrumentation. Fusion involves placing bone graft around spinal instrumentation (cages, rods, screws, plates) to incite bone to grow together into a solid construct. Spine surgery can be performed from the back or front of the spine. Your surgeon will explain which procedure is best for your spondylolisthesis and answer your questions.

Is a brace necessary after surgery?
Many patients need to wear a brace after low back surgery. The brace is worn for three to six months, or until x-ray demonstrates the spine is fusing well. Patients must have a good attitude about post-operative bracing because wearing the brace as instructed will help ensure a good surgical outcome.