If you consider a vertebral segment as consisting of three legs like a tripod, the front of the vertebrae is the large vertebral body and the two legs in the back are the articular facets. The spinal cord passes between these three legs as it travels its course from the brainstem down to the tail bone, with spinal nerve roots exiting each vertebral level to innervate various parts of the body. Spondylolisthesis is a term used to describe when one vertebra shifts forward with respect to an adjacent vertebra, typically in the lower back. In some instances, the patient may not experience symptoms, but in other cases, they may experience localized pain or pain that radiates along the course of the nerve that exits the spine at that level. Spondylolisthesis is generally classified by its suspected cause: degenerative, isthmic, traumatic, dysplastic, or pathologic.
- Degenerative spondylolisthesis develops gradually over time due to degenerative disk disease and other age-related changes and is NOT due to fracture. Hence, the entire vertebrae slides forward over the other and can distort the path of the spinal cord. This is more common in adults over 50 years of age, more often in females than males.
- Isthmic spondylolisthesis results from defects in a small bony area between the front and back of the vertebra called the pars interarticularis, which is often caused from repeated microtrauma into hyperextension of the spine. This is more common in young athletes.
- Traumatic spondylolisthesis results from a singular traumatic event, such as when the lumbar spine is struck by a heavy object. Fortunately, this type rarely occurs, but when it does, it’s more often found in working-age males.
- Dysplastic spondylolisthesis is congenital and secondary to variations in facet joint orientation or abnormal alignment. There is also research that suggests a genetic component exists in that spondylolisthesis is more common if a first-degree relative has the condition.
- Pathological spondylolisthesis is caused by a systemic disease such as infection, osteoporosis, or neoplasm. It may also manifest as a complication from spine surgery.
The good news is that more than three quarters of spondylolisthesis patients may experience a full recovery with chiropractic treatment. Doctors of chiropractic will often employ a multimodal treatment approach that includes patient education, at-home care with heat/ice, manual therapies; specific exercises; supplement recommendations; and physiotherapy modalities such as electrical stimulation, ultrasound, cold laser, and pulsed magnetic field. When necessary, your chiropractor will team up with an allied healthcare provider to manage more complicated cases.