With spondylolisthesis the condition usually declares itself by the fact that the person has recurrent back pains, often at a younger age and starting with very little lifting or awkward postures.
X-rays are usually ordered at one point, which then show the congenital abnormality. One of the more common malformations of the spine is a condition called spondylolisthesis.
Here there is a forward slippage or back slippage of one vertebral body on the other. This happens because of a weakness in the bony support of the side arches of the affected level, which in time through the weight of the body results in the slippage. As the nerve roots and the spinal cord do not tolerate pressure, this translates into lower back pain, nerve root irritation and in severe cases in spinal cord compression.
There is a rating system from grade I to V (thanks to www.spineuniverse.com for the link). Most cases are milder cases , such as grade I and II. The spondylolisthesis becomes unstable when it progresses to a grade III.
There are two subclasses, grade IIIA and IIIB. Grade IIIA can be observed and can still be treated conservatively with a back brace. However, grade IIIB needs medical instrumentation and spinal fusion surgery.
All of these cases need regular follow-up examinations and CT scans or MRI scans to monitor how stable the condition is. Ref. 7 has followed a group of spondylolisthesis patients for 40 years and found that the patients did better without surgery, provided their condition was stable and did not progress beyond the grade IIIA stage. It is good medical practice to have a baseline consultation with a neurosurgeon, even at the lower grades and to have repeat examinations over the years by the same specialist so that any spinal instability beyond grade III A is detected early.
1. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999.
2. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 52.
3. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 275,p.2429.
4. HA King Orthop Clin North Am 1988 Apr;19(2):247-255.
5. HA King Orthop Clin North Am 1999 Jul;30(3):467-474, ix.
6. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 59.
7. JA Smith Orthop Clin North Am Jul 1999; 30(3): 487-499.
8. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 56, p. 469.
9. Wheeless’ Textbook of Orthopaedics: http://www.wheelessonline.com/ortho/arthritis
10. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders
11. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
12. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier