Spinal degeneration can lead to lower back pain and other symptoms. One form of this is degenerative spondylolisthesis or DS. It is described as a disorder that causes a vertebral body to slip over the one beneath it. One of the reasons to see a spine specialist, DS affects mostly the lumbar spine and may lead to pain. While degenerative spondylolisthesis sounds complicated, it can be cured without spine surgery.
Surgery will be picked as the best lower back pain treatment if there is substantial neurologic impairment. If there is no such a problem, your doctor will first apply non-surgical cures. When surgery is suggested, two options will often be preferred: decompression and stabilization (fusion) surgeries. Any of these surgeries can be selected based on the doctor’s symptomatology and radiographic results.
How to tell you have DS
Pain in your back can be caused by different things, explaining why you should get examined by a qualified spine specialist. This is particularly important if there is a chance that you have degenerative spondylolisthesis. Some victims can have DS without symptoms and their only chance to know they have it may appear after doing spinal radiographs for a different problem. When there are symptoms however, they will often include the following:
- Pain in the buttock
- Pain and/or weakness in one or both thighs and legs.
- Lumbar spine pain and tenderness
- Having taut hamstrings
- Having a protruding belly
- Wobbly movements when walking
- Inability to control your bowel movements and urination
Symptoms can be mild, severe or absent. While DS is known to make a vertebra body to slip forward, this does not show that the disorder is advancing. The affected vertebral segment can remain stable without triggering a single neurologic problem. If it triggers neurologic effects, like urine and bowel incontinence, the best lower back pain treatment then would be fusion and instrumentation surgery.
This surgery can be particularly helpful when the vertebral body slippage goes beyond three millimeters as it can re-stabilize the spinal column. In order to arrive at a decision to perform surgery, the spine specialist will consider the person’s medical history, radiographic findings, symptoms and the angle and extent of the vertebral slippage. While fusion surgery is known to produce great results, it is not very useful to people who smoke tobacco or are obese. Nicotine in tobacco hinders the fusion surgical process; obesity puts extreme pressure on the lower back area.
What triggers degenerative spondylolisthesis?
Spondylolisthesis that requires effective lower back pain treatment has numerous causes. These causes have been categorized by doctors in the following ways.
- Dysplastic or congenital spondylolisthesis(Type I)
Type I refers to a type of DS that a child is born with. It is a birth defect in the child’s vertebra’s articular processes. Type I spondylolisthesis occurs in the L5-S1 area; this is where your lumbar and sacrum meet. The L5 is the last vertebra in your lower back or lumbar spine and congenital spondylolisthesis permits it to slip over your sacrum. Type I can be discovered by a competent spine specialist near you.
- Isthmic spondylolisthesis(Type II)
There is a particular region of the vertebra called pars interarticularis that gets affected when one has Type II spondylolisthesis. The condition is further classed into three other kinds: Type II A, Type II B and Type III C. Those affected by Type II A spondylolisthesis are the weight lifters and those who do gymnastics. It occurs when the pars interarticularis undergoes lots of small fractures because of overuse and hyperextension.
In Type II B spondylolisthesis, the main cause is the same micro-fractures that lead to Type II A except that the pars interarticularis do not break totally. So in Type II B the pars will heal as new bones form. This will make it longer, causing the vertebra to slip forward. Type II C spondylolisthesis occurs when there is total fracture of the pars and it is mostly because of trauma or the impact generated in a vehicle accident, for instance.
When there is a pars fracture, a mobile bone fragment called a Gill fragment can form and it could pinch a spinal nerve root. This can lead to pain that would warrant a surgical lower back pain treatment to remove the bone. The micro-fractures in the pars interarticularis are generally referred to as spondylolysis. But, if these fractures cause a vertebra to slip forward because of lack of adequate support, the problem now becomes spondylolisthesis.
- Type III spodylolisthesis
This kind is generally associated with the normal aging process. As we age, there are certain areas of our spine that will begin to degenerate and wear away. The intervertebral discs are the first ones to be affected by age-related degeneration. So the water and proteoglycan in the discs become less and less and this reduces their ability to handle shock and movement. Another problem that can occur is that less fluid in discs can cause them to become thinner. And as the discs thin, the facet joints will come closer together and stop controlling your spinal movements. Overtime, a vertebra body can slip forward as it is not properly held in place when the spine moves. If there is Type III spondylolisthesis, the spine specialist will find it at the your L4-L5 area of your lower back. Ladies older over fifty years old might therefore need osteoporosis treatment and Type III spondylolisthesis treatment.
- Type IV spondylolisthesis
This is usually equated to Type II C spondylolisthesis. It usually entails a fracture affecting any part of the vertebra except the pars interarticularis. For instance, Type IV can entail a fracture of the facet joint and this would separate the front segment of the vertebra from its back segment. Only a qualified provider of lower back pain treatment can discover a Type IV spondylolisthesis problem.
- Type V spondylolisthesis
This kind occurs when there are tumors on the vertebra. Not only do these cause bones to weaken but can also result to serious fractures that would split the vertebra. This can cause a vertebral slip and spinal instability. Again the only best way to recognize if you suffer from this problem is to call a spine specialist in your area.
- Iatrogenic(Type VI) spondylolisthesis
This type of spondylolisthesis is an aftermath of surgery that somehow caused a vertebra to slip forward. Laminectomy spine surgery is the kind that is mostly known to trigger Type VI spondylolisthesis. When pars interarticularis are weakened by surgery, this problem can result.
On the whole, degenerative spondylolisthesis will happen due to birth defects, fractures, spondylolysis, age-related disc degeneration, surgery and spinal tumors.
How is DS diagnosed?
Certain tests and exams for diagnosing spondylolisthesis exist. However, the biggest challenge is recognizing that you have spondylolisthesis. If it is not causing symptoms, you will not even need lower back pain treatment. It is possible that the day you will find out that you have any type of DS your spine specialist will be doing an X-ray to look for a totally different back problem.
If it is found via X-rays, further testing via CT scans might be unnecessary. Sometimes an X-ray is taken from a back angle (oblique) to locate problematic pars interarticularis, lamina or facet joints. To see if spondylolisthesis is making your spine unstable, your lower back pain treatment team might order a flexion X-ray and/or an extension X-ray. When this is being taken, the victim will be bending forward while an extension one will be taken with them bending backward.
If the spine specialist wants to confirm their findings with a CT scan, they will perform it too. Sometimes a slipped vertebra body presses on a nerve root, causing pain. This problem can be discovered through a myelogram test that involves an injection with a given type of dye into the area around the affected nerves. A CT scan or an X-ray will be done next to come up with a clearer and detailed image of your spinal anatomy, including the bones. The spine specialist will then locate abnormalities and determine how to treat them.
Apart from the aforesaid diagnostic tests, your spine and osteoporosis treatment doctor will as well ask about your medical history and do a physical exam and a neurological exam. During a physical exam, he or she will only be interested in checking your joints’ range of motion, back posture and any condition that might cause back pain. They will do this by feeling or palpating your spine, noting any abnormal alignment and curvature and identifying any spine movements that cause pain. It is not uncommon to be asked to walk while your lower back pain treatment expert observes your walking posture.
That’s because people with spondylolisthesis tend to walk abnormally. A neurological exam is all about studying your muscle strength, reflexes, how your pain travels and nerve changes. Some people may feel lower back pain that shifts to the buttock, thigh and/or leg and the doctor will want to note this. Another point to note is that pain due to a slipped vertebral disc is graded based on the results of the lateral or side X-ray. Your slippage will therefore be classed anywhere from Grade I to Grade V. If the extent of slip is beyond 99 percent, meaning that the vertebra is completely off the vertebra beneath it, the case is an extreme one—spondyloptosis.
How is degenerative spondylolisthesis treated?
One way to cure spondylolisthesis is via medicines. This form of lower back pain treatment can be effective, depending on the extent of disc slippage. Commonly, doctors prescribe strong drugs like narcotics, anti-depressants and muscle relaxants. As a result, these drugs are prescribed on a short-term basis as long-term use can lead to addiction. If there seems to be a muscle spasm in the lumbar spine area, a muscle relaxant may be prescribed for just a week. The spine specialist will prescribe anti-depressants if the pain is interfering with your sleep and causing emotional stress.
Physical therapy is also a common lower back pain treatment for spondylolisthesis and can be used together with a brace. This device will be needed to keep the lumbar area stable and less strained. As for physical therapy, it will entail certain kinds of therapeutic exercises like stretches; these will make the trunk muscles more flexible. Still, your spine specialist or therapists might include other exercises that can increase your muscle endurance, strength and coordination and reduce your weight and emotional stress.
If the two conservative techniques fail to deliver good results and symptoms continue to worsen, your spine specialist might suggest surgery. The most likely type of surgery is spinal fusion and instrumentation. This combination is great for spondylolisthesis victims. During the spinal fusion surgery, the doctor harvests the patient’s own bone from their pelvis area or gets a donor bone. In spinal instrumentation, certain medically-made implants like cages, rods and screws are used.
These implants are used to secure the loosened vertebral segment and aiding the fusion process. If rapid pain relief and recovery is the main goal, instrumentation will facilitate it. After instrumentation, a victim might not even need a brace to increase lumbar support. While this lower back pain treatment technique is sometimes inevitable, most people are able to improve with just medicines, a brace and physical therapy.
Final word
As you age, you can expect certain degenerative processes to take part in your spine. One of these can be degenerative spondylolisthesis and it may not be symptomatic. While it is a possibility, DS may not even affect you as you age as it is only a small portion of the population that struggles with it. However, if you are unlucky to have it, the best thing to do is to seek the assistance of the best lower back pain treatment clinic in your area. This medical team there will be able to diagnose the type of spondylolisthesis you have and determine the right ways to cure it. Sometimes the best cure is surgery, although it your spine specialist will do when all non-surgical cures fail. It might offer quick pain relief depending on how successfully it is done and the percentage of the vertebral slip.