Spondylolisthesis - Slipped Vertebrae

The lumbar area of your spine is located in your lower back.  It forms the curve below your waist.  Five large vertebrae make up the lumbar spine.  Ligaments and muscles connect to the spinal column and provide stability and movement.

The back part of each vertebra arches to form the lamina.  The lamina creates a roof-like cover over the back opening in each vertebra.  The opening in the center of each vertebra forms the spinal canal.  Your spinal cord and spinal nerves travel through the protective spinal canal.

Spondylolisthesis results when a vertebra slips out of position in the spinal column.  Degenerated or fractured bones can cause a vertebra to move.  A condition called spondylolysis, a stress fracture, can lead to spondylolisthesis.  A slipped vertebra can press on nerves or narrow the spinal canal.

Spondylolisthesis may not cause symptoms.  It can cause lower back pain and stiffness.  Muscle spasms can cause your hamstring muscles to tighten, change your posture, and interfere with walking. 

If your vertebra has slipped significantly, you may experience compressed nerves or a narrowing of your spinal canal.  If the spinal nerves on the lower end of the lumbar spine are compressed leg pain and neurologic symptoms can result.  Other symptoms include low back pain, leg pain, leg weakness, lower body sensory deficits, and reduced or absent leg reflexes.

Your doctor can diagnose spondylolisthesis by reviewing your medical history and examining you.  You should tell your doctor about your symptoms.  You will be asked to perform simple movements to help your doctor assess your muscle strength, joint motion, and spine stability.  X-rays are used to view your vertebral alignment.  Additional imaging studies are usually ordered to document spinal canal narrowing or nerve root compression.

Spinal fusion surgery is used to correct vertebral slippage associated with spondylolisthesis.  Spinal fusion permanently connects two or more vertebrae to stop movement and relieve pain.  A bone graft and surgical hardware, such as screws and rods, are used to secure the vertebrae together.  A lumbar laminectomy may also be necessary.

 

A lumbar laminectomy is a surgical procedure that relieves pressure on the spinal cord and nerves by enlarging the spinal canal where it is narrowed.  To do so, a surgeon removes all or part of the lamina.

Asymptomatic or minimally symptomatic spondylolisthesis does not require treatment.  Nonoperative treatment is appropriate for many symptomatic patients.  Surgery is necessary when the slipped vertebra is unstable, when symptoms are severe, and when nerve compression causes neurological symptoms.
 
Physical and occupational therapy usually follows spinal fusion and lumbar laminectomy surgeries.  Initially, your physical therapist will help you with bed mobility and sitting balance.  Your physical therapist will also focus exercises to promote walking.  You may need to wear a back support or use an assistive device, such as a walker, until you are stronger.  Your physical therapy will progress to strengthening exercises to increase your back and abdominal muscles strength and endurance. 
 
Your occupational therapist will teach you ways to perform simple daily tasks, such as dressing, bathing, and toileting, within the movement parameters that you have.  Your therapists can recommend and issue durable medical equipment, including shower chairs or dressing devices, to allow you to perform self-care tasks as independently as possible.

Spinal fusion and lumbar laminectomy surgeries require a short inpatient hospital stay followed by a period of physical therapy.  Recovery can take several months.  The length of your recovery may depend on the extent of your condition and the type of surgery that you had.  Your doctor will let you know what to expect.