The prefix ‘Spondylo‘ means vertebra and/or spinal coloumn, and ‘Olithesis‘ means to slip. Therfore it would make sense that a spondylolisthesis is a slip forward of a vertebra in relation to the adjacent level, and a retrolithesis is a slip backwards. The latter is far less common and consequently we will concentrate mainly on the spondylolithesis although, there are some refereneces to this in the links found at the base of the page. (Because of the rareness, there is far less literature available regarding this)
A spondylolisthesis can be caused by a number of factors including congenital (born with it), traumatic and degenerative. There is thought to be a significant relationship to genetic predisposition in non traumatic cases. The most widely used tool for differential diagnosis is the grading system shown below initally conceptualised by three spinal surgeons Wiltse, Newman and McNab.
Unfortunately unless you are able to interpret this (which most of you probably won’t) it will be meaningless however an excellent site from Back.com explains these very effectively so rather than doing that here I would urge you to Click Here and read this before continuing. Identifying the the causal effect is important in the formaulation the management startegy that will need to be implented. The other important factor in this equation is the degree of slippage.
The slippage of the vertebra can be graded into five separate catagories as shown below:
The most common level of spondylolisthesis is that of Grade 1, the lowest level. Many of these examples will infact be indentified during investigations for problems other than those regarding the spine, with many being completely asymptomatic. If the condition is producing symptoms however, but the vertebra is considered ’stable’, (that is, there no immediate danger to the integrity of the nervous system or associated structures) the most widely used intervention is that of conservative exercise management such as physiotherapy or Pilates. This will normally be implemented with a high degree of success. Here is an example of a Grade 1 slip.
Sometimes adjunctive therapy such as epidural injections may be used in the management of a spondylolisthesis. This is not a stand alone treatment but is sometimes administered to give a temporary, pain free window, in which to build the muscular support sufficiently. If the spondylolisthesis is considered unstable and presents a significant risk to the nervous system, surgical mangement may then be necessary and this will probably consist of corrective surgery with the posiibility of a fusion. This approach is considered only as the last resort, normally where conservative treatment has either been ineffective or was considered inappropriate originally. Any surgical intervention should be formulated on a patient by patient basis and therefore no further information can really be given.
High grade Spondylolisthesis cases are very uncommon and thus pictorial examples are extremely hard to come across, even with the vast resources of the WWW. For those of you with that curiosity factor however there is a grade 3 slippage contained within the content of the ‘Chirogeek‘ link below. All the links below give excellent explanations in the context of spondylolistheis.
Chirogeek (more complex) Wiki (retrolisthesis)
