Lumbar Spondylolisthesis

Lumbar spondylolisthesis occurs when a vertebra in the low back slips forward or backward in relation to the vertebra below it. This condition is graded based on how far the vertebra has slipped, ranging from mild (Grade I) to severe (Grade V). The more severe the slippage, the greater the chance of symptoms and complications.

There are different types of lumbar spondylolisthesis based on the cause. The most common types include degenerative (due to aging) and isthmic (due to small fractures in the spine), though it can also result from injury, congenital defects, or certain medical conditions.

Symptoms of lumbar spondylolisthesis can vary widely depending on the severity of the condition. Some individuals may remain asymptomatic, while others experience debilitating pain and neurological deficits. Common symptoms include:

• Lower back pain: Persistent or intermittent pain localized to the lower back is often the first symptom.
• Leg pain or sciatica: Pain, tingling, numbness, or weakness radiating down one or both legs and into the feet due to nerve compression.
• Muscle tightness or spasms: The muscles around the affected vertebra may become tense, causing additional discomfort.
• Reduced range of motion: Stiffness in the lower back can limit flexibility and movement.
• Leg weakness: Severe cases may lead to instability, making it challenging to maintain balance or stand for extended periods.
• Loss of bladder or bowel control: Rarely, in serious cases involving significant nerve compression can cause this, requiring immediate medical attention.

The causes of lumbar spondylolisthesis vary depending on the type of the condition. Key contributing factors include:

1. Degenerative Changes: Degenerative spondylolisthesis is the most common form in older adults and is caused by the natural aging process. Over time, the spinal discs lose water content and elasticity, leading to instability in the vertebral joints. Arthritis and facet joint degeneration further exacerbate the condition.
2. Stress fractures: Repeated stress or small fractures in a part of the vertebra called the pars interarticularis can lead to isthmic spondylolisthesis. This often affects athletes who engage in activities that involve frequent bending and arching of the back, such as gymnastics or football.
3. Trauma: Accidents or trauma, like falls or car crashes, can damage the spine and cause a vertebra to slip out of place.
4. Congenital Abnormalities: Some people are born with structural issues in their spine that make it more likely for a vertebra to slip.
5. Medical conditions: Certain conditions, like tumors or infections in the spine, can weaken the vertebrae and lead to slippage.
6. Genetics: A family history of spondylolisthesis or other spinal conditions may increase the risk of developing this condition.

Diagnosing lumbar spondylolisthesis involves a combination of understanding your symptoms, performing a physical exam, and using imaging tests to confirm the condition. Dr. Lauren Boden takes a thorough and personalized approach to diagnosis to ensure you get the care you need.

Medical History

The diagnostic process begins with a detailed discussion of the patient’s symptoms, lifestyle, and medical history. Patients are asked about the onset, duration, and nature of their pain, as well as any previous injuries or family history of spinal conditions.

Physical Examination

During the physical exam, Dr. Boden evaluates the patient’s posture, spinal alignment, and range of motion. Specific tests, such as the straight-leg raise test, may be used to assess nerve irritation or compression. Reflexes, muscle strength, and sensory function are also checked to identify any neurological deficits.

Imaging Tests

Advanced imaging is crucial for confirming the diagnosis and understanding the extent of the condition:

• X-rays: Standard X-rays provide a clear view of the spine and can reveal vertebral slippage, abnormal alignment, and degenerative changes.
• MRI: MRI scans offer detailed images of soft tissues, including discs, nerves, and ligaments, helping to identify nerve compression or damage.
• CT Scans: CT scans provide cross-sectional views of the spine, offering greater detail of bone structures and fractures.

Functional Testing

In cases where nerve function is compromised, Dr. Boden may recommend electromyography (EMG) or nerve conduction studies to evaluate the electrical activity of affected nerves and muscles.