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  Degen. Spondylolisthesis
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DEGENERATIVE SPONDYLOLISTHESIS
Overview
Symptoms
Low back pain, buttock pain, leg pain, weakness in the lower extremities, numbness or burning in the leg, bowel or bladder incontinence.


General Overview
Spondylolisthesis is a Latin term for slipped vertebral body. "Spondylo" means vertebrae and "listhesis" means slippage. One type of spondylolisthesis, degenerative spondylolisthesis, describes a condition of forward slippage of one vertebrae in the spine over another, usually occurring at age greater than 60. This condition in adults is most commonly due to degeneration, wear and tear, of the discs and ligaments in the spine.

Degenerative SpondylolisthesisIn degenerative adult spondylolisthesis, the discs and the facet joints lose their ability to support the spine and resist gravity therefore, with weight bearing, one vertebrae slips in relation to the other. Back pain is the most common symptom, but severe nerve compression can occur with numbness in the legs, tingling and weakness, particularly with activities. Imaging studies such as MRI and CT scans can show "stenosis," or pinched nerves in the spinal canal. The CT and MRI scan are obtained with the patient lying down and therefore can miss a slippage. This is why we obtain flexion, extension and standing X-rays, as well as myelograms.

Osteoarthritis of the facet joints can also lead to instability of a vertebral segment. Typically, as continued degeneration weakens the facet joints, the L4 vertebral body slips forward on the L5 vertebral body. Since the L4-L5 segment is the area with the most flexion-extension type movement, this area is most likely to slip. The next most likely level is L3-L4, and rarely L5-S1. This is contrary to isthmic spondylolisthesis that occurs most often at L5-S1.

As the body tries to capture the unstable segment, the facet joints get bigger and place pressure on the nerve root causing lumbar spinal stenosis. Therefore, both the symptoms and conservative treatment for degenerative spondylolisthesis are essentially identical as for patients with lumbar spinal stenosis.

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