Spondylolisthesis is a spinal condition that impacts children, teenagers, and adults alike. As a prominent cause of back pain, members of the medical community have long been working to more effectively diagnose and treat this disorder.
Physicians use a grading system to evaluate the severity of spondylolisthesis. Whether caused by a spinal abnormality or age-related degeneration, spondylolisthesis cases benefit from the grading system, as well as the advanced treatment options available today.
This article will cover spondylolisthesis grades and groups, as well as the treatments available for all types of this spinal condition.
Understanding Spondylolisthesis
Spondylolisthesis occurs when the spinal instability causes one of the spinal bones, called vertebrae, slips out of its usual position. The affected vertebra slips forward onto the bone beneath it.
Asymptomatic cases of spondylolisthesis do exist. This is because while the vertebra may be misaligned, it doesn’t necessarily press on spinal nerves.
However, if the misaligned vertebra imparts pressure on the spinal nerves or spinal cord, a variety of symptoms may develop. The most common symptoms of spondylolisthesis include back pain, back stiffness, hamstring muscle spasms, and neurological symptoms (such as numbness, tingling, and weakness in the legs and feet).
What Are The Different Spondylolisthesis Grades?
Different grades are used to quantify the severity of spondylolisthesis. Physicians use the spondylolisthesis grades as a tool in diagnosing this spinal condition.
Grade 1 spondylolisthesis is the least severe, or advanced, while grade 5 is the most advanced. To determine the grade of this spinal condition, physicians measure how much of the vertebral body (the main part of the vertebra) has slipped forward.
The grades of spondylolisthesis include:
- Grade 1: 25% slippage of the vertebral body
- Grade 2: 50% slippage of the vertebral body
- Grade 3: 75% slippage of the vertebral body
- Grade 4: 100% slippage of the vertebral body
- Grade 5: the vertebra has completely fallen off
Grade 5 spondylolisthesis is rare. Also known as spondyloptosis, this condition requires surgery.
How Do Doctors Grade Spondylolisthesis?
To determine the grade of a case of spondylolisthesis, physicians may conduct different exams and tests. However, most often, physicians take a lateral, or side, x-ray of the spine. X-rays allow physicians to view the inside of the body – namely the bones.
With an x-ray of the spine, your doctor will be able to measure the grade of spondylolisthesis and more effectively develop a treatment plan.
Spondylolisthesis Groups
In addition to the grading system provided above, spondylolisthesis can be classified based on its cause. Spondylolisthesis classifications can help patients better understand their condition.
The following classifications were published in 1976 and, today, are widely considered the main classifications of spondylolisthesis:
- Dysplastic
Dysplastic spondylolisthesis results from a pars interarticular is defect that’s present at birth. In a sizable sample population, this group accounted for 14% to 21% of spondylolisthesis cases.
- Isthmic
Isthmic spondylolisthesis results from an irregularity or fracture in the pars interarticularis. It’s considered a prevalent cause of persistent back pain in adolescents, especially those who participate in athletics.
- Traumatic
Traumatic spondylolisthesis involves an acute, or sudden shift in a vertebral body. It’s caused by a sudden injury or impact to the spine. Oftentimes, traumatic spondylolisthesis stems from an auto accident or sports injury.
- Degenerative
Degenerative spondylolisthesis is the most common among older individuals. It results from the natural aging process. As we get older, the spine degenerates and becomes less stable, which increases the likelihood of a spinal injury like spondylolisthesis.
- Pathological
Pathological spondylolisthesis stems from a problem in the bone tissue. It may be caused by bone disease, tumors, and certain cancers. This form of spondylolisthesis is considered rare.
Spinal Peculiarities
As we learned above, spondylolisthesis can result from anatomical peculiarities or abnormalities. Specifically, dysplastic spondylolisthesis results from a spinal deformity, most commonly in the spinal segment L5-S1. This segment is also known as the lumbosacral joint and is located in between the lumbar and sacral spine.
With dysplastic spondylolisthesis, the facet joint of the spine doesn’t form properly. As a result, the pars interarticularis doesn’t provide enough support for the vertebrae. This can cause a vertebra to slip out of position, leading to spondylolisthesis.
Spondylolisthesis Treatment
Low-grade spondylolisthesis is treated with conservative methods. Your physician may recommend rest, physical therapy, pain medication, and/or steroid injections. Exercises for spondylolisthesis can help strengthen the muscles that support the spine to reduce the impact on the injured vertebrae.
Bracing is also commonly used for cases of spondylolisthesis, especially those that involve a pars interarticularis fracture. Back braces immobilize the spine to prevent further vertebral slippage.
Grade 4 and grade 5 spondylolisthesis often requires surgery.
Spondylolisthesis Surgery
For spondylolisthesis patients who require surgery, physicians typically recommend spinal decompression with fusion. These are two different processes that can be completed in a single procedure.
Spinal Decompression
Spinal decompression involves alleviating pressure on the spinal nerves. This may be done in several different ways, although laminectomy is the most common.
During a laminectomy, the surgeon removes a portion (or all) of the lamina. The lamina is a section of bone that covers the back of the spinal canal. By removing some or all of it, the surgeon can take pressure off of the affected nerves for spondylolisthesis symptom relief.
Spinal Fusion
Spinal fusion is often done after decompression to stabilize the spine. This procedure involves using bone graft material to fuse the affected vertebrae into one bone. Unfortunately, this process eliminated the patient’s ability to move at the fused segment.
As one of the available spine fusion alternatives, a spondylolisthesis surgery implant can be used to help patients with spondylolisthesis. Used in combination with procedures like spinal laminectomy, a non-fusion spine device can stabilize the spine without severely inhibiting the patient’s motion. This results in a faster spine surgery recovery and improved overall outcomes.
If you’re struggling with symptoms of spondylolisthesis, visit your physician for a thorough evaluation. Your physician can help you get on the path to complete pain relief.