reportedly underwent spinal surgery for chronic back pain caused by spondylolisthesis.
Spondylolisthesis occurs when a vertebra slips forward onto the vertebra below, explained Jessica Stark, MD, a spine surgeon at UTHealth Houston. This misalignment, a result of arthritis, most often occurs in the lumbar spine and can put pressure on the nerves around the spine.
“In fact, an arthritic back can have varying degrees of spondylolisthesis throughout the spine simply because the joints have grown and become misaligned in different places,” Stark said. MedPage today.
The level of pain depends on the degree of slipping and how the spondylolisthesis occurred. When patients come in with this condition, Stark begins by assessing the severity and how much the condition impacts the patient's life. Many report back and leg pain or numbness.
“I always tell patients that pain is kind of a warning sign of nerve compression, but numbness and weakness is actual nerve damage,” Stark said. “When we get to the point of weakness, we actually start to worry because that's when the nerve gets damaged quite severely, and sometimes, especially with certain nerves, when there's so much pressure put on them, you become so weak that the nerve actually can't recover anymore.”
She noted that people can develop spondylolisthesis for a variety of reasons.
Degenerative spondylolisthesis, the most common form, results from wear and tear of bones rubbing against each other over time. This most often occurs at age 50 and older. Some people, such as those who do manual labor or participate in impact sports, wear out their bodies from these high-impact activities and are more likely to develop arthritis or herniated discs sooner, or to develop spondylolisthesis. Women and African Americans are also more likely to develop degenerative spondylolisthesis, according to the American Academy of Orthopedic Surgeons.
For those born with birth defects or pars fractures—abnormalities in the part of the bone in the back of the spine that holds joints in place—the bones may become misaligned at an earlier age, perhaps even during adolescence. Traumatic fractures of body parts, most often resulting from motor vehicle accidents or falls, can also lead to spondylolisthesis.
“Obviously, acute injuries, like trauma, cause more nerve damage because it happens suddenly and their nerves haven't been stretched for a long time, so they don't have that protective healing of the nerve roots that happens slowly,” Stark explained.
Treatment often begins with core-strengthening physical therapy to relieve pressure on the spine, long-acting anti-inflammatory medications such as celecoxib (Celebrex) or meloxicam, and possibly muscle relaxants or pain medications such as gabapentin (Neurontin). For some, this level of intervention is sufficient.
But if the condition does not improve or worsens within 6 weeks, the next step is injections every few months. Stark said this typically involves an epidural steroid injection into the lumbar region, which provides an anti-inflammatory effect along with lidocaine for short-term pain relief. Like other similar injections, a lumbar epidural steroid injection works best the first time and becomes less effective with each injection.
Surgical stabilization of the spine with four screws and two rods is a last resort and definitive treatment. Stark said most surgeons also clear the disc and insert “some type of interbody lining, which is a cage, into the disc space to allow for an anterior fusion as well, because there's a lot of stress on those screws and rods and they can fail over time.” This gives the intervention a better chance of success, she said.
Once the vertebrae have been stabilized, the first point of spinal movement is one level higher, which slightly increases the risk of arthritis at that level. About 20 years after surgery, some people require a second surgery at a level higher than the first.
The silver lining to this difficult condition is that some of the most effective treatments are relatively new, Stark said.
“I can fix it with a small cut less than an inch,” she said. “I think it’s good that we can do this, and 10 years ago this was not possible.”
