Spondylolisthesis… Have you heard of this problem? This is a fairly common cause of low back pain, but most of the patients who have it don’t seem to know, or understand, what it is. This wouldn’t surprise me, but even patients who have seen other doctors, don’t understand their own problem.
This long word literally means spine slippage, and it’s a reference to one vertebra, i.e. bone, slipping forward from the bone below it. This can happen as a young person, such as from a fracture of the bone from forced hyperextension activities, such as in gymnasts who forcefully hyperextend their backs at the end of their routines. It can happen anywhere in your spine, but is most common in the lower back.
The more common cause is simply the degeneration of the joints, whose role is to permit, but limit movement, and their degeneration can cause them to become “incompetent” at their restricting function, permitting too much movement. This tends to be a slowly progressive pathology, and when the slip increases to about 25%, it tends to become an intractable cause of pain, which requires surgery to correct, with a fusion to the vertebra below, in a normal position.
This problem usually presents in older persons in their 40’s or 50’s and slowly progresses. In the earlier stages, such as when it has slipped less than 25%, it will usually cause occasional pain and be amenable to improvement with non-surgical treatment, such as chiropractic, physical therapy or injections. If surgery is required, and it is the only problem present, the prognosis is good, if done by the right surgeon. This kind of surgery must be done the right way. Some surgeons have no business doing this kind of surgery, and I have seen some terrible surgical outcomes when done by surgeons who are not skilled in this specific type of surgery.
When I find this problem in a patient, I make sure to explain the problem very simply and with anatomical models, because I want the patient to know exactly what is the problem. I also explain the usual progression of this problem, so that if, in the future, their pain becomes refractory to non-surgical improvement, they know that it’s time to see an expert in this surgical procedure. As always, my duty is to explain the pathology to patients, explain how to improve it now, if possible, and what to anticipate in the future. Of course, patients can always call me in 2, 5, 10 or 20 years to ask me for a referral but I want to make sure they remember not to just go to anyone for surgical treatment in this very specific scenario. There are many other spinal surgical procedures that are relatively simple to do and which have a good prognosis with most surgeons, but in the case of spondylolisthesis, patients need a surgeon who specializes in this problem.
Thankfully, most patients with spondylolisthesis do not need surgery and I can help them get better relatively quickly. If you need Decatur chiropractic or Decatur physical therapy, call me at 404-558-4015. You can learn more at www.backstrong.net and link to my Youtube channel from there.
Craig Castanet, D.C.
Backstrong Non-Surgical Rehab Clinic