This condition usually affects the lumbosacral joint, which is the 5th lumbar vertebra upon the sacrum (the large triangular bone at the end of the spine). On rare occasions it can affect other areas of the spine. Children, young adults, and older adults can be affected. The severity of the spondylolisthesis is classified as Grade 1, 2, 3 or 4. Basically, what happens is that the 5th lumbar vertebra slides forward on the sacrum. Depending on how much the forward slippage is, determines the grade.
The causes can be a sudden severe trauma, fracture to a part of the bone, or a degeneration of the vertebral joint or to the disc. A trauma, such as a sudden severe stretching of the low spinal area that can occur in weightlifting, gymnastics, basketball, football, or any sport that places increased stress on the lower back. A spondylolisthesis due to a trauma is usually found in the younger adult because they are more apt to engage in more sports activities, where there is body contact of a violent nature. The degenerative spondylolisthesis will occur in older adults, especially if they are engaged in work where heavy lifting and bending is necessary, and also participate in strenuous sports. Anything that exposes them to a sharp, sudden stress to the low back area can cause the onset of spondylolisthesis. Pathological conditions of the disc, such as degeneration, wearing down and ruptured disc, can cause a hyper mobility of the 5th lumbar vertebra resulting it to slide forward on the sacrum.
With all the preceding causes of spondylolisthesis, lax abdominal and back muscles due to a sedentary life-style, may be the most important causative factor. The loss of the needed muscle support predisposes the individual to spinal trauma.
As the population of 50 and over increases, more cases of spondylolisthesis due to degenerative changes will be seen. An increase of approximately 10% to 25% is not only probable, but also certain. This increase will be due to seniors working longer before retirement, and to the rise in athletic activities, such as running, bowling, golfing, tennis, etc. Additional causes can be attributed to a congenital defect that affects the articulation of the 5th lumbar vertebra, and/or the sacrum. Being overweight by 20 or more pounds will add insult to injury, and not having the needed muscle support, places the individual in jeopardy.
Spondylolisthesis can be an extremely painful condition causing a variety of symptoms and prolonged disability. The symptoms can be severe, causing low back pain, with pains that can also radiate into the groin, buttock and lower extremity. In men the groin pain will most likely affect the testicle. There can also be neurological symptoms, such as numbness and tingling affecting the leg. These symptoms are due to a decrease in the size of the foramen (opening) through which the spinal nerve exits the spine. This narrowing of the opening causes the nerve to be pinched, thus irritating the nerve, setting up the syndrome of radiating pain. The side on which the nerve is pinched will determine the side of pain. In men the testicular pain will be reflected in the testicle on the pinched nerve side, and can be a sharp pain or neuralgia.
If these symptoms occur following a traumatic event, the individual should consult his Chiropractor or Physician in order to diagnose and evaluate the condition. Once the diagnosis and evaluation has been made, they will then determine the course of treatment. Depending on the severity of the condition, especially if a fracture is present, the treatment of choice would be immobilization of the lumbosacral area with an orthopedic lumbar belt. Complete rest is also indicated. The belt should be worn for at least 3 months, but during this time, physiotherapy and conservative Chiropractic care can help alleviate pain and muscle spasm. During very severe painful episodes, the individual may want to sleep with the belt on, but it should be removed for a few hours during the day when the individual is at rest. In rare instances, where the vertebra has been severely fractured, surgical intervention may be necessary.
In the older patient, where the onset of the symptoms has been gradual over a period of years, they too must be diagnosed and evaluated and the proper treatment started. Getting treated doesn’t preclude the individual with spondylolisthesis from helping themselves. Instituting an at home self-care program can prevent further deterioration of their condition. If they are a grade 1 they can prevent a progression to grade 2, and so on, and so on. The prevention of this progression will also prevent the more serious symptoms from occurring, saving the individual some very painful episodes.
The at home program should consist of hot showers, morning and evening, letting the shower strike the back for 5 to 10 minutes at a time. Using an analgesic gel applied 3 to 4 times daily to the lumbosacral area will calm and alleviate some of the pain. A massage to the lumbar muscles and buttock areas will help reduce muscle spasms. During this period of self-care they should also wear the orthopedic lumbosacral belt during the day, and if necessary during sleep hours. If not at work, or when at rest, remove the belt for several hours during the day as mentioned previously.
If the individual must return to work, extreme caution must be exercised in not aggravating the condition by over-doing. This means they should take every precaution, not to bend too much or lift anything over 5 pounds. Any individual that is over weight must try to loss any excess poundage. An obese person with a large abdomen places more stress on the lumbosacral area by helping gravity place pull on the already stressed spine. They must make a concerted effort to drop this weight, for their condition and their health in general.
After a treatment regime as described above is started, the individual should respond in approximately 2 to 3 months. If the response is not favorable, they should be re-evaluated. However, following their doctor’s advice, and the concentrated effort they use at home, will in all probability preclude this, and result in a complete recovery. Now, during all this self-care, the individual must start an exercise program as soon as they can start moving freely without pain. The exercise program will strengthen the abdominal and back muscles. It is these muscles that play such an important role in the support of the spine. The ideal program for strengthening and as a preventive, is the “Doctor’s Senior Exercise” program. It is a no impact, total body workout that is performed in the home, and takes only 15 to 20 minutes. Starting your program is only the first step. Dedicating yourself to continuing the program on a daily basis is your second step, and that will determine the results and how you feel and how you will enjoy life.