What is degenerative spondylolisthesis. How is it diagnosed. What are the treatment options for this spinal condition. What causes L4-L5 spondylosis. When is surgery necessary for spondylolisthesis.

Understanding Degenerative Spondylolisthesis: Causes and Symptoms

Degenerative spondylolisthesis is a spinal condition characterized by the forward slippage of one vertebra over another, typically occurring in the lumbar spine, with the L4-L5 region being the most common site. This condition primarily affects individuals over 60 years old, with a higher prevalence among women.

The primary cause of degenerative spondylolisthesis is age-related wear and tear on the spine, leading to the breakdown of vertebral components. Unlike isthmic spondylolisthesis, there is no bone defect present in the degenerative form.

Common symptoms of degenerative spondylolisthesis include:

• Low back pain radiating to the buttocks and legs
• Muscle spasms
• Leg weakness
• Tight hamstring muscles
• Irregular gait or limp
• Sciatica (in some cases)

It’s worth noting that some individuals with spondylolisthesis may be asymptomatic, only discovering the condition during unrelated medical examinations.

Diagnostic Approaches for Degenerative Spondylolisthesis

Accurate diagnosis of degenerative spondylolisthesis is crucial for effective treatment. Healthcare professionals employ various diagnostic tools and techniques to confirm the condition:

1. Medical history assessment
2. Physical examination
3. Imaging studies (X-rays, CT scans, MRI)
4. Myelogram (in select cases)

During the physical examination, doctors assess limitations in movement, balance issues, pain levels, reflex responses, muscle weakness, and signs of neurological damage. Imaging studies help rule out other conditions such as tumors or infections while confirming the diagnosis of spondylolisthesis.

The Meyerding Grading System

The Meyerding Grading System is commonly used to classify the severity of vertebral slippage in spondylolisthesis. This system categorizes the condition based on the percentage of forward slip of one vertebral body over the one below:

• Grade I: 1-24% slip
• Grade II: 25-49% slip
• Grade III: 50-74% slip
• Grade IV: 75-99% slip
• Grade V (spondyloptosis): 100% slip

Most cases of degenerative spondylolisthesis fall under Grade I or Grade II. The grading helps guide treatment decisions, with higher grades more likely to require surgical intervention.

Non-Operative Treatment Options for Degenerative Spondylolisthesis

For mild to moderate cases of degenerative spondylolisthesis (typically Grades I and II), non-operative treatments are often the first line of defense. These may include:

• Temporary bed rest
• Activity modification
• Pain and anti-inflammatory medications
• Steroid-anesthetic injections
• Physical therapy
• Spinal bracing

The goal of these conservative treatments is to alleviate pain, reduce inflammation, and improve overall function. However, it’s important to note that degenerative spondylolisthesis can be progressive, meaning symptoms may worsen over time despite conservative management.

Surgical Interventions for Severe Degenerative Spondylolisthesis

In cases where non-operative treatments fail to provide relief or when the condition is severe (usually Grade III or above), surgical intervention may be necessary. The most common surgical procedure for degenerative spondylolisthesis is a laminectomy with fusion.

Laminectomy and Fusion Procedure

During a laminectomy, the surgeon widens the spinal canal by removing or trimming the laminae (roof) of the affected vertebrae. This creates more space for the nerves and relieves pressure on the spinal cord. The procedure is often combined with spinal fusion to stabilize the affected vertebrae.

Spinal fusion involves joining two or more vertebrae together to prevent further slippage. Various devices, such as screws or interbody cages, may be implanted to enhance fusion and support the unstable spine.

Complications and Long-Term Outlook of Degenerative Spondylolisthesis

While degenerative spondylolisthesis can be effectively managed in many cases, it’s important to be aware of potential complications and the long-term outlook for those affected by this condition.

Potential Complications

• Spinal stenosis: Narrowing of the spinal canal, potentially leading to nerve compression
• Chronic pain: Persistent low back pain or sciatica
• Neurological deficits: Weakness, numbness, or tingling in the legs
• Cauda equina syndrome: A rare but serious condition affecting the bundle of nerves at the base of the spine

The long-term outlook for individuals with degenerative spondylolisthesis varies depending on the severity of the condition and the effectiveness of treatment. Many patients experience significant improvement with conservative management or surgical intervention, while others may have ongoing symptoms requiring long-term management.

Preventive Measures and Lifestyle Modifications for Degenerative Spondylolisthesis

While it’s not always possible to prevent degenerative spondylolisthesis, certain lifestyle modifications and preventive measures may help reduce the risk or slow the progression of the condition:

• Maintaining a healthy weight to reduce stress on the spine
• Regular exercise to strengthen core and back muscles
• Proper posture and body mechanics during daily activities
• Avoiding smoking, which can accelerate spinal degeneration
• Ergonomic adjustments in the workplace to minimize spinal strain

Incorporating these practices into daily life may help individuals manage symptoms and potentially delay the need for more aggressive treatments.

Emerging Treatments and Research in Degenerative Spondylolisthesis

As medical science advances, new treatments and research initiatives are continually emerging in the field of spinal disorders, including degenerative spondylolisthesis. Some areas of ongoing research and development include:

• Minimally invasive surgical techniques
• Stem cell therapies for spinal regeneration
• Advanced imaging technologies for more precise diagnosis
• Novel pain management approaches
• Artificial disc replacement as an alternative to fusion

These emerging treatments offer hope for improved outcomes and quality of life for individuals affected by degenerative spondylolisthesis. However, it’s important to note that many of these approaches are still in the experimental stages and require further study before becoming widely available.

Living with Degenerative Spondylolisthesis: Coping Strategies and Support

For many individuals, living with degenerative spondylolisthesis requires ongoing management and adaptation. Developing effective coping strategies and seeking appropriate support can significantly improve quality of life:

Coping Strategies

• Pain management techniques (e.g., meditation, relaxation exercises)
• Adaptive equipment for daily activities
• Pacing activities to avoid overexertion
• Stress reduction techniques
• Regular exercise within prescribed limits

Support Resources

• Support groups for individuals with spinal conditions
• Physical therapy and rehabilitation services
• Occupational therapy for workplace adaptations
• Mental health counseling to address emotional aspects of chronic pain
• Patient education programs on spinal health

By actively engaging in self-care and utilizing available support resources, individuals with degenerative spondylolisthesis can better manage their condition and maintain a higher quality of life.

The Role of Interdisciplinary Care in Managing Degenerative Spondylolisthesis

Effective management of degenerative spondylolisthesis often requires a multidisciplinary approach, involving various healthcare professionals working together to provide comprehensive care. This interdisciplinary team may include:

• Orthopedic surgeons or neurosurgeons
• Pain management specialists
• Physical therapists
• Occupational therapists
• Radiologists
• Rheumatologists
• Nutritionists
• Mental health professionals

Each member of the team contributes their expertise to create a personalized treatment plan that addresses all aspects of the patient’s condition. This holistic approach ensures that both the physical and psychological impacts of degenerative spondylolisthesis are addressed, leading to better overall outcomes.

Benefits of Interdisciplinary Care

• Comprehensive assessment of the patient’s condition
• Coordinated treatment planning
• Improved communication between healthcare providers
• Better management of comorbid conditions
• Enhanced patient education and empowerment

By leveraging the collective expertise of multiple specialists, patients with degenerative spondylolisthesis can receive more tailored and effective care, potentially improving their prognosis and quality of life.

Rehabilitation and Recovery After Spondylolisthesis Treatment

Whether a patient undergoes conservative treatment or surgical intervention for degenerative spondylolisthesis, rehabilitation plays a crucial role in recovery and long-term management of the condition. The rehabilitation process typically involves:

Physical Therapy

• Strengthening exercises for core and back muscles
• Flexibility and range of motion exercises
• Posture training
• Gait training
• Pain management techniques

Occupational Therapy

• Adaptations for activities of daily living
• Ergonomic assessments and recommendations
• Energy conservation techniques

Pain Management

• Medications (as prescribed by a physician)
• Non-pharmacological pain relief methods
• Psychological support for chronic pain management

The duration and intensity of rehabilitation vary depending on the severity of the condition and the type of treatment received. Patients who undergo surgery typically require a more extensive rehabilitation program compared to those managed conservatively.

Adherence to the rehabilitation plan is crucial for optimal recovery and prevention of future complications. Patients are often encouraged to continue with a home exercise program and maintain regular follow-ups with their healthcare team to monitor progress and make necessary adjustments to their treatment plan.

Future Directions in Degenerative Spondylolisthesis Research and Treatment

As our understanding of degenerative spondylolisthesis continues to evolve, researchers and clinicians are exploring new avenues for diagnosis, treatment, and prevention of this spinal condition. Some promising areas of investigation include:

Genetic Research

Scientists are studying genetic factors that may predispose individuals to developing degenerative spondylolisthesis. Identifying specific genetic markers could lead to earlier interventions and personalized treatment approaches.

Advanced Imaging Techniques

Innovations in medical imaging, such as functional MRI and molecular imaging, may provide more detailed insights into the biomechanics of the spine and the progression of degenerative changes.

Regenerative Medicine

The use of stem cells and growth factors to promote tissue regeneration in the spine is an area of active research. These approaches aim to slow or reverse the degenerative process that leads to spondylolisthesis.

Robotic-Assisted Surgery

Advancements in robotic technology are enhancing the precision and minimally invasive nature of spinal surgeries, potentially leading to improved outcomes and faster recovery times for patients requiring surgical intervention.

Artificial Intelligence in Diagnosis and Treatment Planning

AI-powered algorithms are being developed to assist in the diagnosis of spinal conditions and to help predict treatment outcomes, allowing for more personalized and effective care strategies.

As research in these areas progresses, it is hoped that new breakthroughs will lead to more effective prevention strategies, improved diagnostic accuracy, and enhanced treatment options for individuals affected by degenerative spondylolisthesis. Continued investment in spinal research and collaboration between scientists and clinicians will be key to advancing our understanding and management of this complex condition.

Degenerative Spondylolisthesis Treatment & Surgery

Spondylolisthesis – Degenerative

Spondylolisthesis is a spinal condition in which one vertebra slips forward over the vertebra below. Degenerative spondylolisthesis, usually occurs in the lumbar spine, especially at L4-L5. It is the result of degenerative changes in the vertebral structure that cause the joints between the vertebrae to slip forward. This type of spondylolisthesis is most common among older female patients, usually those over the age of 60.

Symptoms
Symptoms of spondylolisthesis may include the following:

• Pain, especially after exercise, in the low back, thighs, and/or legs that radiates into the buttocks and/or down the legs (sciatica)
• Muscle spasms
• Leg weakness
• Tight hamstring muscles
• Irregular gait or limp

Some people with spondylolisthesis are symptom free and only discover the disorder when seeing a doctor for another health problem. However, the forward slip of the vertebral body in severe cases of degenerative spondylolisthesis often leads to spinal stenosis, nerve compression, pain and neurological injury.

What Causes Degenerative Spondylolisthesis?

Degenerative spondylolisthesis is usually the result of age and “wear and tear” on the spine that breaks down vertebral components. It is different from isthmic spondylolisthesis in that there is no bone defect. Spinal stenosis tends to occur in the early stages of degenerative spondylolisthesis.

Diagnosis

Correct diagnosis is obviously essential. Dr. Lonner utilizes the latest diagnostic technologies, combined with examinations by expert physicians, to ensure that the diagnosis is accurate. Diagnostic tools include:

• Medical history. You will be asked about your symptoms, their severity, and the treatments you have already tried.
• Physical examination. You will be carefully examined for limitations of movement, problems with balance, pain, loss of reflexes in the extremities, muscle weakness, loss of sensation or other signs of neurological damage.
• Diagnostic tests. Generally, we start with x-rays, which allow us to rule out other problems such as tumors and infections. We may also use a CT scan or MRI to confirm the diagnosis. In some patients a myelogram will be used. This is a test that involves the use of a liquid dye that is injected into the spinal column to show the degree of nerve compression, slippage between involved vertebrae, and abnormal movement.

Classification of Spondylolisthesis

There are several methods used to “grade” the degree of slippage ranging from mild to most severe. We will discuss with you the extent of your spondylolisthesis.

In general, physicians use the Meyerding Grading System for classifying slips. This is a relatively easy to understand system. Slips are graded on the basis of the percentage that one vertebral body has slipped forward over the vertebral body below. Thus a Grade I slip indicates that 1-24% of the vertebral body has slipped forward over the body below. Grade II indicates a 25-49% slip. Grade III indicates a 50-74% slip and Grade IV indicates a 75%-99% slip. If the body completely slips off the body below it is classified as a Grade V slip, known as spondyloptosis.

Dr. Lonner will consider the degree of slip, and such factors as intractable pain and neurological symptoms, when deciding on the most suitable treatment. Most degenerative spondylolisthesis cases involve Grade I or Grade II. As a general guideline, the more severe slips (especially Grades III and above) are most likely to require surgical intervention.

Non-Operative Treatment

For most cases of degenerative spondylolisthesis (especially Grades I and II), treatment consists of temporary bed rest, restriction of the activities that caused the onset of symptoms, pain/ anti-inflammatory medications, steroid-anesthetic injections, physical therapy and/or spinal bracing.

Degenerative spondylolisthesis can be progressive – meaning the damage will continue to get worse as time goes on. In addition, degenerative spondylolisthesis can cause stenosis, a narrowing of the spinal canal and spinal cord compression. If the stenosis is severe, and all non-operative treatments have failed, surgery may be necessary.

Surgical Treatment

Surgery is rarely needed unless the case is severe (usually Grade III or above), neurological damage has occurred, the pain is disabling, or all non-operative treatment options have failed.

The most common surgical procedure used to treat spondylolisthesis is called a laminectomy and fusion. In this procedure, the spinal canal is widened by removing or trimming the laminae (roof) of the vertebrae. This is done to create more space for the nerves and relieve pressure on the spinal cord. The surgeon may also need to fuse vertebrae together. If fusion is done, various devices (like screws or interbody cages) may be implanted to enhance fusion and support the unstable spine.

Patient Story of Degenerative Spondylolisthesis

Explaining Spinal Disorders: Degenerative Spondylolisthesis

Home > Conditions > Degenerative Spondylolisthesis

Spondylolisthesis is a spinal condition in which one vertebra slips forward over the vertebra below. Degenerative spondylolisthesis usually occurs in the lumbar (low back) spine, more commonly at L4-L5 (4th and 5th lumbar vertebral levels). Spondylolisthesis can result from degenerative changes in the vertebral structure that causes the joints between the vertebrae to slip forward and may lead to spinal stenosis. Degenerative spondylolisthesis is most common among older female patients, usually over age 60.

Slip of L5 vertebra on sacrum

Symptoms

Some people with spondylolisthesis are symptom-free and discover the disorder when seeing their doctor for another health problem. Symptoms may include:

• Low back pain
• Sciatica ?Muscle spasms
• Leg weakness
• Tight hamstring muscles
• Irregular gait or limp

Diagnosis

Our comprehensive diagnostic process includes:

• Medical history. The doctor asks you questions about your symptoms, their severity, and treatments you have already tried.
• Physical examination. You are carefully examined for limitations of movement, problems with balance, and pain. During the exam, the doctor looks for loss of reflexes, muscle weakness, loss of sensation or other signs of neurological injury.
• Diagnostic tests. Most doctors start with x-rays. Spondylolisthesis is easily seen on a lateral (side) lumbar x-ray. If necessary, a CT scan or MRI may be ordered to see the spine’s tissues in greater detail.

X-ray showing spondylolosthesis

Lumbar spine MRI showing spondylolosthesis

Classification of Spondylolisthesis

Information from your medical file and imaging studies is used to grade the degree of vertebral slippage from mild to severe. The grade of your spondylolisthesis is explained to you along with what it means.

Doctors use the Meyerding Grading System to classify the degree of vertebral slippage. This system is easy to understand. Slips are graded on the basis of the percentage that one vertebral body has slipped forward over the vertebral body below.

• Grade I: 1-24%
• Grade II: 25-49%
• Grade III: 50-74%
• Grade IV: 75%-99% slip.
• Grade V: Complete slip (100%), known as spondyloptosis

Your doctor considers the degree of slip and factors, such as intractable pain and neurological symptoms, when deciding on the most suitable treatment. Most cases of degenerative spondylolisthesis are Grade I or II. As a general guideline, the more severe slips (Grades III and above) are most likely to require surgical intervention.

Nonoperative Treatment

Most cases of degenerative spondylolisthesis are treated without surgery. Treatment may include:

• Short-term bed rest
• Activity restriction
• Over-the-counter or prescription pain medication
• Anti-inflammatory medication
• Muscle relaxants
• Steroid injections (i. e. epidural steroid injection)
• Physical therapy
• Bracing

Degenerative spondylolisthesis can be progressive. This means the spondylolisthesis worsens with time and may cause spinal stenosis. This is why it is important to follow-up with your doctor to monitor your treatment progress and spondylolisthesis.

Surgery

If your degenerative spondylolisthesis progresses or causes neurologic problems, such as incontinence, surgery may be recommended. Spinal instrumentation (i.e. rods, screws) and fusion (bone graft) are common procedures performed to stop slip progression and stabilize the spine. There are different types of instrumentation, bone graft and graft products, as well as procedures (some minimally invasive) to surgically treat degenerative spondylolisthesis. Your surgeon will explain how your surgery will be performed, as well as the benefits and risks of the procedure.

Bone model showing interbody cages, screws and rods

Conclusion 

Degenerative spondylolisthesis does not mean you have to live in pain. We can help you return to a healthy, pain-free and active life. For most patients this is accomplished with nonsurgical treatments. But, even if surgery is needed, be assured we will discuss all procedure risks and benefits and provide you with the best possible care.

In addition treatments, our medical professionals have a deep commitment to patient education. By helping you understand the cause of your condition, we can help you eliminate risk factors and instill spine healthy habits for a lifetime. While you are under our care, our medical staff will provide you with excellent information to help you recover, minimize risk factors, and stay healthy.

Spondylosis of the lumbosacral spine, symptoms, causes and treatment

Spondylosis of the lumbosacral spine is a disease that is characterized by damage to the joints of the lower back, the growth of osteophytes. Bone formations appear mainly along the anterior edge of the vertebrae, and the lateral regions are also affected. The pathological process is associated with excessive loads, unsatisfactory physical condition of a person. In parallel with this, muscle spasm is observed, which limits mobility in the lumbosacral region. If there is no adequate treatment, then the bone growths become larger, infringe on the nerve roots and spinal cord.

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact a specialist.

Symptoms of the disease, signs

The initial stage of lumbar spondylosis proceeds almost imperceptibly. In the modern rhythm of life, many people do not pay attention to the slight stiffness in movement. The further the disease develops, the more noticeable the symptoms become:

• soreness in the loins, buttocks and legs;
• lameness, intense discomfort in calf muscles;
• inability to fully bend over.

The pain gets worse in the evening, and also when trying to move more or less actively. Often a person has to take forced postures. At 2-3 stages progress:

• paresthesia;
• loss of sensation of the skin of the buttocks;
• Difficulty in movements of the knee joints, leg abduction in the hip joints.

With an increase in the duration of the disease, the symptoms of spondylosis of the lumbosacral spine become more acute and interfere with a normal lifestyle. In some cases, the signs of pathology intensify when the weather changes.

It is important to distinguish osteochondrosis from spondylosis. With osteochondrosis, pain with pressure on the spinous processes is not noted. And for spondylosis, this is a characteristic manifestation. When it affects the lumbosacral spine, predominantly L3-L5 suffer. Osteochondrosis in most cases affects the L5-S1 vertebrae.

Causes of lumbar spondylosis

Pathological growth of bone tissue is caused by degenerative changes that lead to a deterioration in the mobility of the spinal column. They are provoked by:

• direct and indirect injuries of the local muscle-ligament apparatus;
• prolonged stay in a physiologically incorrect position;
• dynamic loads on the muscles with obvious hypodynamia;
• infectious lesions;
• neoplasms;
• genetic predisposition;
• overweight.

Cause the development of spondylosis age-related changes in the tissues of the spine, as well as constitutional predisposition. Abnormal growth of the bone structure can be observed under the influence of oncological diseases. Both hypo- and hyperdynamia pose a certain health hazard.

Effective treatments

The prescribed therapy should take into account the special properties of the human body. Treatment methods for lumbar spondylosis are aimed at: restoring a full blood supply; improvement of the condition of cartilage tissue; elimination of pain; strengthening muscles and ligaments.

Therapy includes pharmacological and non-pharmacological methods. Among medicines positive effect is exerted by:

• NSAIDs;
• muscle relaxants;
• preparations of natural cartilage components.

If the lumbar region is affected, spondylosis responds well to physiotherapeutic methods:

• acupuncture;
• ultrasound;
• paraffin packs;
• manual therapy;
• massage.

After relief of acute pain, exercise therapy is started. Therapeutic gymnastics has a restorative and healing effect.

What if the disease is not treated?!

With timely diagnosis and treatment, the prognosis is quite favorable. However, attempts to independently stop the pain syndrome or ignore the symptoms lead to the progression of the pathology. Over time:

• limbs become numb;
• mobility is sharply limited;
• muscles atrophy;
• partial or complete immobilization occurs.

Lumbar spondylosis responds well to treatment. It is important to contact a competent specialist who will make an accurate diagnosis and individually select a comprehensive treatment regimen.

Lumbar spondylosis – symptoms, causes, treatment

A neurologist treats this disease.

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Spinal spondylosis is a chronic disease resulting from degenerative-dystrophic processes of the fibrous ring of the intervertebral disc. Spondylosis is one of the types of osteopathies – diseases grouped according to common characteristic features: dystrophy of the structures of the spine, pain syndrome, limitation of mobility. It affects all parts of the spinal column, but most often the lumbosacral.

CMRT specialist tells

Kuchenkov A.V.

Orthopedist • Traumatologist • Surgeon • Phlebologist • Sports doctor • 25 years of experience

Publication date: May 18, 2021

Verification date: January 10, 2023

All facts have been verified by a doctor.

Contents of the article

Causes of spondylosis

Symptoms of spondylosis of the lumbosacral spine

The initial stage of the disease is characterized by a latent course. As the pathological process progresses, symptoms appear:

• Limited mobility in the lumbar spine.
• Unpleasant sensations in the buttocks and thighs after prolonged exertion on the legs
• Pain in the back after prolonged static posture

Deforming spondylosis of the lumbar spine gives the following symptoms:

• Lumbar pain when turning the body, when walking down stairs
• Lameness when pain radiates to the lower extremities

Antespondylolisthesis (displacement of the vertebrae relative to each other) causes pinching of the nerves of the “cauda equina”, which is located in the lower parts of the spinal cord. In the clinical picture, neurological symptoms come to the fore:

• Severe pain in the perineum, in the legs
• Development of paresthesia – a feeling of numbness, tingling, burning below the level of damage to the spinal segment: lower back, buttocks, legs
• Increasing weakness of the muscles of the lower extremities
• Disorder of the pelvic organs: violation of the process of urination, defecation

Stages of development of spondylosis

The process of degenerative changes in intervertebral discs with the formation of osteophytes successively goes through several stages:

I stage. There are initial changes in the fibrous tissues of the intervertebral disc: cracks, fractures, decreased elasticity. Single spiny bone growths (osteophytes) do not extend beyond the vertebral bodies. Symptoms characteristic of spondylosis of the lumbosacral spine are absent, the patient may sometimes be bothered by minor pain in the lumbar region.

Stage II. Active proliferation of osteophytes continues. Mobility in the damaged spinal segment decreases, pains join, the intensity of which increases with physical exertion, hypothermia.

Stage III . Complete destruction of cartilage. Bone growths, increasing in size, merge into rough osteophyte complexes connecting two or more vertebrae. This disrupts the normal mobility of the lumbar spine. When osteophytes compress the nerve roots of the spinal cord, neurological disorders develop, aggravated by a severe pain syndrome.

How to diagnose

If spinal spondylosis is suspected, diagnostics include:

• Collection of patient complaints, as well as information about the onset and course of the disease
• Clinical examination by a doctor with assessment of neurological status
• Instrumental examination: X-ray in frontal and lateral projection x, CT, MRI can detect pathological changes in bone, cartilage, soft tissues in the early stages.