What Does Your Spondylolisthesis Diagnosis Mean?


middle aged female doctor looks at x-ray of spine next to diagram of spine with a senior female patient.

Your physician has just given you a diagnosis that you’ve never heard of, and can barely pronounce: spondylolisthesis. What is this odd condition?

Pronounced “spon-dl-oh-lis-THEE-sis,” this condition involves your vertebrae—the bones that form the building blocks of your spine. However, many people don’t experience any back pain. Generally, spondylolisthesis causes pain in your legs when you walk or stand for long period of time.

If you have been diagnosed, there’s no need to panic. Spondylolisthesis can certainly be an annoyance—sometimes a major one—but it is not dangerous.

Here are 3 things to know if you have received a spondylolisthesis diagnosis.

There Are Several Types Of Spondylolisthesis

Think of your washing machine. If it's like most others, its parts will wear down over time. How quickly it wears down will depend on things like the size of your family … and how messy they are.

Now imagine your son leaves rocks in his pocket, which you forget to empty. The washing machine goes into its 80-mile-per-hour spin cycle. BOOM. Now there's a long crack in the drum, and your messy son is grounded.

Spondylolisthesis can work the same way. Andrew H. Milby, MD, physician at Penn Medicine, describes two types:

  • Degenerative spondylolisthesis happens when the spine wears down. It doesn't happen to everyone, but when it does, it varies from patient to patient. One person might get spondylolisthesis in his 40s, while another one might not get it until his 70s.

There is no known reason why some people develop spondylolisthesis from wear and tear, while others do not. As Dr. Milby says, “It’s completely random—just a case of bad luck.”

  • Isthmic spondylolisthesis happens when you get a small fracture (break) in your bone because of an injury or a developmental “weak spot.”

It’s estimated that about 5 to 7% of the population has isthmic spondylolisthesis, but very few actually experience symptoms. Those who do tend to start noticing the symptoms during adolescence.

The exact bones that are affected can vary from person to person. But generally, isthmic spondylolisthesis occurs a little lower in the spine than degenerative spondylolisthesis.

The diagnosis process varies a bit between the two types. Since degenerative spondylolisthesis is more likely to cause noticeable symptoms—such as lower back pain, leg pain, or leg aches—it’s usually diagnosed after a patient complains of these symptoms, and the physician orders an X-ray or an MRI.

Isthmic spondylolisthesis doesn’t always cause symptoms, so it’s often found when a patient is getting an X-ray for an entirely different problem.

Spondylolisthesis Is Not The Same As A Slipped Disc—But Does Involve Slippage

Slippage is a key element of spondylolisthesis.

Dr. Milby likes to use the word “slippage” because it conjures up a visual image of what’s happening in the body. He explains, “When you have spondylolisthesis, one of the vertebrae—the bones that make up your spine—slips out of place over another.”

However, it’s not the same thing as a slipped disc.

In fact, the phrase “slipped disc” is not even medically accurate. “The term ‘slipped disc’ doesn’t really make sense, as there isn’t actually any slippage,” says Dr. Milby. “When people say they slipped a disc, they’re usually confusing it with disc herniation—the disc ruptures, allowing the jelly-like center to leak and irritate nearby nerves.”

And while herniation and spondylolisthesis can share some symptoms, like leg pain or weakness, Dr. Milby explains that there are a few differences.

“When you have a herniated disc, the pain is usually constant. With spondylolisthesis, you tend to just have pain when you stand or walk. Once you sit or lie down, your body seems to ‘reset’ itself, relieving pain.”

Also read: Herniated Disc Disorders

Spondylolisthesis Doesn’t Necessarily Need Treatment

“Not everyone needs treatment,” says Dr. Milby. “Spondylolisthesis is not dangerous or life-threatening, so treatment isn’t always medically necessary. It’s a quality of life decision that you have to make for yourself.”

If you do decide to get treatment, there is good news: There are multiple treatment options available, and they tend to be very successful.

Dr. Andrew Milby discusses Penn having access to the latest and greatest treatments and technologies.

Often, pain from spondylolisthesis can be treated with weight loss, pain medications (e.g., ibuprofen, oral steroids), heat or ice, or physical therapy. If those methods are not successful, your physician may talk to you about surgery.

In general, there are two main categories of lower back surgery:

  • Surgery to relieve pressure on nerves (decompression)
  • Surgery to restore stability (fusion)

Since spondylolisthesis involves a slippage, or instability, of the bones, spinal fusion is often the most appropriate choice for spondylolisthesis. During this procedure, the surgeon will connect your vertebrae to keep them in place and reduce abnormal movement in the spine.

Dr. Milby recognizes that not everyone wants to jump into surgery. Although it’s usually extremely successful, surgery does come with risks and can involve a long recovery period.

“Fusion gets a bad name as a treatment for low back pain, but it can greatly improve quality of life if you have severe spondylolisthesis,” says Dr. Milby.

“That being said, remember that there is no urgency whatsoever to have surgery. The pain will not get worse quickly, or paralyze you,” he adds. “It’s comparable to a hip or knee replacement—it can have a great impact on your life, but you will not be in danger if you choose not to have it.”

If you are considering surgery, Dr. Milby recommends getting into shape as much as you can and laying off the nicotine—people who smoke have slower bone healing and a higher risk of infection after spinal fusion surgery.

Also read: Spinal Fusion: The 5 “W’s” You Should Know About

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