Spondylolisthesis is the displacement of one vertebra on top of another. This displacement can occur when there is significant acute damage to the area, from a contact sports injury say, or as a result of more chronic issues such as cervical degenerative disc disease, osteoarthritis, and other cervical spinal issues. Unchecked, degenerative spondylolisthesis can lead to cervical spinal stenosis (Kalichman, 2008).
Physicians usually classify spondylolisthesis according to its cause, with the most common being degenerative spondylolisthesis. This is caused by chronic degenerative changes in the ligaments, facet joints, bones, and cartilage that hold the spinal/vertebral column in position. This degeneration can lead to spondylolisthesis as the vertebral column loses its ability to stay together and the vertebrae slip out of position. Isthmic spondylolisthesis is the result of spondylolysis; a defect in the pars interarticularis (part of the vertebrae) most commonly caused by repetitive microtrauma in childhood through activities such as gymnastics, diving, soccer, football, and wrestling (Standaert, 2000).
Traumatic spondylolisthesis is due to direct trauma inflicted upon the vertebrae causing a fracture of the pedicle, lamina, or facet joints and allowing the front of the vertebrae to move forward. Cervical spondylolysis can lead to spondylolisthesis by altering the normal structure of the vertebral column and causing vertebral displacement. Congenital abnormalities of the facet joints can lead to spondylolisthesis, as the vertebrae are allowed to slip out of place. The condition is referred to as dysplastic spondylolisthesis. A further classification is pathological spondylolisthesis, where a defect of the bone, or a tumour causes the slip to occur.
Understanding the cause means that the correct treatment can be applied, such as adequate rest from the microtrauma-inducing sport, analgesics, anti-inflammatories, physical therapy, or surgery in cases where significant damage has occurred and conservative treatment has proved ineffective. Spondylolysis normally does not require surgical intervention, unless it progresses into spondylolisthesis. The use of a brace may be helpful in reducing neck pain in the meantime. Identifying the exacerbating activity is key to preventing future occurrences of the condition, meaning that correct posture, and core muscle strengthening, along with neck strengthening exercises are key to a positive outcome. In the case of lumbar or cervical spine surgery, typically a spinal fusion is the procedure used to correct spondylolisthesis.
Last Updated: 10/04/2010