When a vertebra misaligns from the rest of the vertebrae, slipping in front of or behind another vertebra, it is called spondylolisthesis. The condition typically can occur as the result of repetitive trauma, during adolescence, or as the result of a failure of certain parts of the spine to naturally grow together. Spondylolisthesis is easily diagnosed using a plain X-ray and is graded based on the percentage of misalignment of the upper vertebrae when compared to the vertebrae below. If you have a severe grade of the condition, you may begin to walk differently and in more of a waddling manner. For patients that complain of pain, heaviness, or numbness in the legs, an MRI scan may be ordered to help identify any compressed nerves. If you have spondylolisthesis, it is likely that you have spinal stenosis at the location of your spondylolisthesis.
Lower Back Symptoms
- Pain in the lower back
- Radiating pain or heaviness in the leg(s) while walking or standing
- Numbness and tingling that radiates down the leg(s)
TREATMENTS FOR SPONDYLOLISTHESIS
There are nonsurgical and surgical treatment options available for spondylolisthesis. Both treatment types are performed by our back, neck, and spine specialist at Orthopaedic Specialists.
As an extensively trained spinal surgeon, Dr. Michael Dolphin’s first approach to the treatment of spondylolisthesis is typically conservative and based on the patient’s severity of symptoms. Rest or avoidance of activities that cause discomfort, physical therapy, anti-inflammatory medications, or epidural steroid injections are examples of common nonsurgical treatments that Dr. Dolphin prescribes. For patients who fail conservative treatment options, surgery may be an option based on the type of spondylolisthesis.
Laminotomy (Minimally Invasive)
Each vertebra of the spine consists of a vertebral body on the front side and a bony canal on the back side. In between each of these is a disc. The back part of the spine, or the bony canal, houses the spinal cord and nerves. The back side of the canal or “roof” of this canal is referred to as the lamina. Minimally invasive laminotomy involves the removal of a small area of this lamina on either one or both sides of the spinal nerves to allow for decompression of the nerves. This alleviates the spinal stenosis associated with the spondylolisthesis. The procedure takes approximately 30 minutes and is done on an outpatient basis. Patients are allowed to return to activity as tolerated immediately, letting their postsurgical pain guide them.
Laminectomy (Minimally Invasive)
Minimally invasive laminectomy is a surgical procedure that removes the entire lamina, or bony “roof” to the spinal nerves. The goal of this procedure is to alleviate pressure on the nerves. This procedure may be utilized in the treatment of spinal stenosis associated with spinal stenosis on select cases. The procedure takes approximately one hour. Patients are typically able to go home on the same day of surgery. Because of the minimally invasive approach used by Dr. Dolphin, patients are allowed to return to activity as tolerated, allowing their postsurgical discomfort to guide them.
Anterior Lumbar Interbody Fusion – ALIF
ALIFs are frequently performed to treat several different types of spinal conditions including but not limited to instability of the spine, degenerated discs, one or more fractured vertebrae or, in many cases, spondylolisthesis. Patients who experience low-back pain as a result of degeneration or spondylolisthesis or those who have not responded positively to nonsurgical treatments are typically good candidates for this procedure. During the procedure, you will be placed on your back and the incision, or approach, is made from the front or anterior of the body. A vascular surgeon aids in accessing the spine by moving through and around the contents within the abdomen. Once these are protected, the disc space is identified and any remaining part of the disc is removed. The surfaces of the vertebrae on either side of the disc space are then realigned and prepared for a fusion. A spacer, filled with a bone graft material, is inserted within the disc space to aid in stabilization of the spondylolisthesis. Over time, the bone graft grows across the disc space and fuses or welds the two vertebrae together. This prevents them from slipping in the future.
eXtreme Lateral Interbody Fusion – XLIF® (Minimally Invasive)
The XLIF procedure is another technique that Dr. Dolphin utilizes to stabilize and correct the spondylolisthesis. This procedure is performed through an incision on a patient's side, thereby avoiding the contents of the abdomen or disruption of the muscles of the back. This is a truly innovative procedure that Dr. Dolphin has lectured on and provided insight to the industry and other physicians learning this technique. It is minimally invasive, requiring a single 1.5 to 2–inch incision. As a result of the minimally invasive nature of this procedure, patients may be discharged from the hospital the day after surgery.
Transforaminal & Posterior Lumbar Interbody Fusion
TLIF and PLIF procedures have been utilized for over a decade in the treatment of spondylolisthesis and other spine conditions. Dr. Dolphin has years of experience performing these procedures. When the pathology, or anatomy, prevents a patient from having a minimally invasive approach, Dr. Dolphin may utilize these techniques to achieve an excellent outcome for the patient.