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DEGENERATIVE SPONDYLOSISTHESIS

Every level of the spine is composed of a disc in the front and paired facet joints in the back. The disc acts as a shock absorber in between the vertebrae, whereas the paired facet joints provide further stability and limit certain motions. They allow the spine to bend forwards (flexion) and backwards (extension) but do not allow for a lot of rotation. As the facet joints age, they can become incompetent and allow too much flexion, allowing one vertebral body to slip forward on the other. This slippage is known as a degenerative spondylolisthesis, which is Latin for “slipped vertebral body”.

Degenerative spondylolisthesis is far more common in individuals older than 65 and is more common in females than males by a 3:1 margin. It is most common at the L4-L5 level of the lower spine, but can also happen at L3-L4. It is relatively rare at the other levels. It may also at multiple levels of the spine.

Symptoms:
With degenerative changes of the spine (enlargement of facet joint and thickening of ligaments), narrowing of the spine can result in spinal stenosis. The symptoms of a degenerative spondylolisthesis are very similar to that of spinal stenosis. Patients usually complain of pain or a tired feeling down the legs when they stand for a prolonged period of time or try to walk any distance (pseudoclaudication). Generally, they do not have a lot of pain while sitting, because in the sitting position the spinal canal is more open. In the upright position, the spinal canal gets smaller accentuating the stenosis and pinching the nerve roots in the canal.

The nerve root pinching can lead to weakness in the legs, but true nerve root damage is rare. There is no spinal cord in the lumbar part of the spine, so even for patients with severe pain; there is no danger of spinal cord damage. If the stenosis becomes very severe, or if the patient also has a disc herniation, they can develop sciatica or pain with rest and even sleep. Back pain and/or leg pain are typical symptoms of degenerative spondylolisthesis. Some patients do not have any back pain with degenerative spondylolisthesis and others have primarily back pain and no leg pain.

Treatment options:
There is a range of non-surgical treatment options (such as pain medications, ice or heat application) that may help with some of the pain of a degenerative spondylolisthesis, but there are really three options a patient will ultimately have to choose from.

  • Activity modification. Modify their activities (spend more time sitting than standing or walking) but continue to challenge their ability to stand and walk. Do not give in to pain completely. Stationary biking as an exercise in the sitting position should be tolerable.
  • Epidural injections. These work to help curb pain and increase a patient’s function in up to 50% of patients, and if it does work it can be done up to three times per year. The length of time that the epidural can be effective is variable as the pain relief can last one week or a year.
  • Surgery. For patients with severe pain and difficulty functioning, surgery can be done that includes a decompression with pedicle screw instrumentation plus spine fusion. Decompression surgery alone is usually not advisable as the instability is still present and a subsequent fusion will be needed in up to 60% of patients.

Contact Us

13710 Olive Boulevard (Primary Office)
Chesterfield, MO 63017
Telephone: 314-469-PAIN (7246)

Fax: 314-469-7251
Exchange: 314-441-6965 (for after-hour Emergencies Only)

Hours:
Monday thru Friday
8:30 AM – 4:30 PM