Lower Back Symptoms:
- Pain in the lower back
- Radiating pain or heaviness in the leg(s) with walking or standing
- Numbness and tingling that radiates down the leg(s)
What is Spondylolisthesis?
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 can occur as a failure for certain parts of the spine to naturally grow together. Spondylolisthesis is easily diagnosed using plain x-ray and is graded based on the percentage of misalignment of the upper vertebra when compared to the vertebra 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 legs, a 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.
As an extensively trained spinal surgeon, Dr. Michael Dolphin’s first approach to treatment of spondylolisthesis is typically conservative and based on the patient’s severity of symptoms. Rest or avoidance of activities that cause the discomfort, physical therapy, anti-inflammatory medications, or epidural steroid injections, are examples of common non-surgical treatments that Dr. Dolphin prescribes. For patients that fail conservative treatment options, then surgery may be an option, based on the type of spondylolisthesis.
Laminotomy (Minimally Invasive)
Each vertebrae 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 is immediately, letting their post-surgical 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 1 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 post-surgical discomfort to guide them.
Anterior Lumbar Interbody Fusion-ALIF
ALIF’s 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, spondylolisthesis or who have not responded positively to non-surgical 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 re-aligned 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 patients 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 industry and other physicians learning this technique. It is minimally invasive, requiring a single 1 ½ 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 and 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.