The Aging Spine:
Scoliosis and Other Spine Deformities
Spondylolisthesis

Each level of the spine is connected to neighboring levels by small joints (facet joints), inter-vertebral discs, and soft-tissues (ligaments and muscles) so that each vertebra aligns properly. This arrangement facilitates spinal motion while protecting the spinal nerves. However, disruptions in the connections between vertebrae or changes in the structure of the vertebrae can result in a condition where one vertebra slips or shifts forward with respect to the level below. This condition is called spondylolisthesis. Since each component of the spine shares in the task of supporting the body, a deficiency in one area means that others have to work harder. As a result, they can wear out more quickly, leading to progression of the slip.

The two most common types of spondylolisthesis are referred to as "developmental" and "degenerative". Developmental slips refer to abnormalities in the way the vertebra and its connections developed from childhood. These slips usually occur at a younger age, often in the teens or in young adulthood. In contrast, degenerative slips refers to the wearing out of previously normal spine. These slips may not manifest until the 50s and are often associated with spinal stenosis and arthritis.

Symptoms and diagnosis

Vertebral slippage causes changes in spinal alignment which, in turn, can lead to back and leg pain. More rarely, other conditions such as leg numbness or weakness can also occur, depending on the severity of the slip. X-rays, along with CT and/or MRI scans are diagnostic. In younger patients a bone scan may be useful as well to help guide treatment. While certain vertebral slippages remain unchanged, others progressively worsen.

Treatment

Initial treatment for back and leg pain from spondylolisthesis usually includes rest, medication, physical therapy, and/or bracing. When symptoms fail to respond to non-operative care or if slips worsen they may reconstructive surgery to stabilize (fuse) the spine and to decompress irritated spinal nerves.

MRI shows severe developmental spondylolisthesis at L5-S1

X-ray shows a degenerative spondylolisthesis at L4-5