Slipping of the back is seen in 5 to 10 percent of patients who visit a doctor for lower back pain. The two most common types of slippage are istmic and degeneratve spondylolisthesis.
"Lumbar slipping" that occurs as a result of a lumbar stress fracture is called "isthmic spondylolisthesis" and is often seen as slipping of the L5 vertebra over S1 vertebra.
Another type of slipping in the lower back is "lumbar shift" that occurs as a result of a wear in the spine and neighboring connective tissues because of aging, seen more frequently after age 40. This condition is named "degenerative spondylolisthesis". Lumbar shift that occurs with aging and wear generally presents as forward slipping of the L4 vertebra over the L5 vertebra. Lumbar shift is often associated with "narrow spinal canal".
How is it Diagnosed?
If your doctor considers isthmic spondylolisthesis after listening to your complaints and physical examination, he will request films. However, stress fracture (spondylolysis) may not be visible on plain X-rays. In that condition, your doctor may order a scintigraphy and/or CT if he still suspects a fracture. If these tests reveal a fracture, an MRI may be needed to plan treatment.
In patients who have slipping, along with leg pain and/or numbness, MRI may also be necessary to evaluate the spinal cord and nerves. The severity of isthmic spondylolisthesis will be determined on a scale from 1 to 4.
Degenerative spondylolisthesis is also diagnosed with plain X-rays and MRI. Scintigraphy or CT may not be necessary in this type of lumbar shift.
What are Treatment Options?
If you complain only of lower back pain, your lumbar shift is not serious, and your doctor did not consider nerve compression or nerve involvement, then non-surgical treatment methods are the first choice. These methods can be one or more of the following: rest, painkillers and anti-inflammatory medications, temporary use of a brace, and physical therapy.
If your pain persists, another treatment is injection of steroids and local anesthetics to the fractured area and joints (facet joints). If there is leg pain and numbness due to nerve compression in addition to lumbar pain, epidural or foraminal injections may be added.
When is Surgery Necessary?
Surgical treatment may be needed for patients whose complaints do not respond to conservative management. Also, if slipping has resulted in a spinal cord compression, which in turn resulted in a neurologic deficit (drop foot, inability to hold urine), immediate surgery may be necessary.
Two types of surgery may be applied in spondylolisthesis. The first is the repair of the fractured area, and the other is spinal fusion.
This surgery is usually successful in patients younger than age 20, with intact (non-degenerated) disks.
The selected procedure in isthmic spondylolisthesis is spinal fusion. If there is associated spinal cord compression, the projections that cause compression are removed to relieve it.
The surgery can be performed from the front, back, or both. Fixation materials may be used. Healing is accomplished with an optimal postoperative rehabilitation program