Spondylolisthesis occurs when one vertebra slips forward in relation to the lower vertebra, usually in the lumbar spine or low back. In younger people (under 18 years old), spondylolisthesis usually involves slippage of the lowest fifth lumbar vertebra over the top of the sacrum, as the angle of the spine at this level is greatest making it easy to slip.
Causes of Spondylolisthesis
Facet joints are the small joints that connect the back of the spine together. Normally, the facet joints connecting L5 to the sacrum create a junction to prevent L5 from slipping forwards on the sacrum. However, when problems exist in the disc, facet joints, or bony ring, the junction becomes weakened, resulting in the L5 vertebra slipping forwards over the top of the sacrum.
Symptoms of Spondylolisthesis
The most common pain is an ache in the low back and buttock areas. Pain is aggravated when bending backward and may be eased by bending the spine forward. Occasional muscle spasm is also common in the low back and buttock muscles.
Treatment of Spondylolisthesis
We will take a careful case history and then examine you in detail, noting your ranges and quality of movement. We will do minor tests for trapped nerves and in some cases may request an X-ray or MRI scan. Many patients with spondylolisthesis develop postural asymmetries over time so an important factor in treatment is the correction of any loss of the normal upright alignment of the pelvis and spine. It is not unusual to see a change in pelvic alignment (often a forward-flexed pelvis) or in lumbar spinal curve with spondylolisthesis. The lumbar changes can be either a hyperlordosis or (in some cases) a lack of normal lumbar lordosis. Patients will need to be shown corrective exercises specific for the postural imbalances.
Although a spondylolisthesis can be serious, the vast majority of injuries are not and can easily be helped by your chiropractor. We should be able to reduce your symptoms to a pain-free level and give you advice and exercise to help prevent future problems.