Anyone experiencing persistent back pain should consider visiting a specialist for an evaluation. A spine specialist may be able to provide a diagnosis for your pain, which is the first step toward getting on the path to recovery.
In this article, we’ll discuss how physicians diagnose spondylolisthesis, as well as the risks of misdiagnosis.
Spondylolisthesis: Understanding This Spinal Condition
Spondylolisthesis is a spinal condition that can impact patients in adolescents and/or adulthood. It develops when a vertebra slips out of its regular position and settles onto the vertebra below it.
Causes of Spondylolisthesis
There are a few reasons why spondylolisthesis may develop. For one, it can result from age-related spinal degeneration. As the spine undergoes wear and tear with age, it can become more unstable, potentially leading to conditions like osteoarthritis and degenerative disc disease. Cases of spondylolisthesis that are caused by age-related spinal changes are known as degenerative spondylolisthesis.
Spondylolisthesis can also develop as a result of a defect or stress fracture in the bone that links the facet joints together (known as the pars interarticularis). When the pars interarticularis is compromised, the spine loses stability, creating the risk of spondylolisthesis.
Symptoms of Spondylolisthesis
Not everyone experiences symptoms from spondylolisthesis. However, if the injured vertebra presses on spinal nerves, you may develop symptoms such as:
- Stiffness in the back
- Back pain, especially when bending the spine forward
- Trouble walking or standing for extended periods
- Spasms in the hamstring muscles
How Is Spondylolisthesis Diagnosed?
Your physician will consider a wide range of factors before providing a spondylolisthesis diagnosis. These factors typically include:
- Medical history
You’ll first need to discuss your medical history with your physician. Your physician will likely ask about when your symptoms began and any potential risk factors for spondylolisthesis in your medical history.
- Physical exam
Your physician will next need to conduct a physical exam. This exam may involve pressing on certain areas of the spine and testing different positions of the legs. Your physician may also ask you to walk around the room and bend forward to evaluate your motion, balance, and gait.
These actions can help determine the origin of your symptoms and whether or not they’re caused by spondylolisthesis.
- Neurological exam
In addition to a general physical exam, your physician may conduct a neurological exam. The purpose of this exam is to determine if you’re experiencing nerve damage.
During the neurological exam, your physician will consider the pattern of the spinal nerves to link your symptoms to specific nerves. This may involve using a small hammer or temperature extremes to test nerve function.
- Imaging tests
Physicians generally conduct imaging tests before providing a spondylolisthesis diagnosis. There are multiple imaging tests that may be used, including an x-ray, CT scan, MRI, and bone scan. These tests show the spine in greater detail to help your physician determine if a vertebra has slipped out of position.
Types of Spondylolisthesis
There are a few different types of spondylolisthesis that you may be diagnosed with. These types include:
- Degenerative
Degenerative spondylolisthesis is caused, as you likely guessed from the name, spinal degeneration. Specifically, this form of spondylolisthesis is triggered by the breakdown of cartilage in the spinal joints due to osteoarthritis.
- Dysplastic
Dysplastic spondylolisthesis is caused by a congenital spinal defect and, therefore, is present at birth.
- Traumatic
Traumatic spondylolisthesis is caused by a traumatic injury to the spine. This mainly includes a fractured pedicle, facet joint, or lamina caused by a sudden impact, such as the impact of a car accident.
- Isthmic
Isthmic spondylolisthesis is caused by a defect or fracture in the pars interarticularis.
- Pathologic
Pathologic spondylolisthesis is caused by a weakness or abnormality of the bones. This can include spondylolisthesis caused by bone disease and tumors (either cancerous or non-cancerous).
Can Spondylolisthesis Be Incorrectly Diagnosed?
As with virtually any medical condition, spondylolisthesis can be incorrectly diagnosed. Since there are many possible causes of spondylolisthesis, including back pain and neurological symptoms, it could be misdiagnosed as other spinal conditions.
The most common conditions for spondylolisthesis to be mistaken for include sciatica and a slipped disc.
The Risks of Spondylolisthesis Misdiagnosis
Spondylolisthesis will generally worsen over time, especially if the patient partakes in activities that strain the spine. Sports and poor posture, in particular, can exacerbate this spinal condition.
A misdiagnosis can delay the process of properly treating spondylolisthesis. This can lead to worsened symptoms and complications, such as:
- Chronic back pain
- Changes in sensation
- Damage to the spinal nerve roots (temporary or permanent)
- Changes in bladder or bowel function (in severe cases)
How is Spondylolisthesis Treated?
After being correctly diagnosed with spondylolisthesis, you’ll begin a treatment plan as recommended by your physician. Most cases of this condition are effectively managed with conservative treatments including:
- Physical therapy
- Lifestyle modifications
- Hot and cold therapy
- Chiropractic care
- Pain medications (either over-the-counter or prescription)
- Epidural steroid injections
Spondylolisthesis Surgery
In severe cases of spondylolisthesis, patients may require surgery. Surgery is generally only recommended for spinal conditions like spondylolisthesis if the patient doesn’t experience any improvement after several months of conservative treatment.
Spinal fusion is commonly performed for spondylolisthesis. It involves fusing the affected vertebrae into a single bone. This eliminates all movement between the vertebrae to prevent instability and alleviate the patient’s symptoms.
Unfortunately, spinal fusion can seriously limit a patient’s range of motion and requires a lengthy recovery process. In fact, spondylolisthesis patients may not fully recover from spinal fusion until a year has passed after the surgery.
Spinal Fusion Alternatives For Spondylolisthesis
Thankfully, medical advancements now allow for severe spondylolisthesis treatment without the need for spinal fusion. Spinal fusion alternatives, like the TOPS spine device, stabilize the spine after spondylolisthesis surgery without compromising the patient’s motion. These alternatives also shorten the spine surgery recovery process so that patients can return to their favorite activities faster.
If you’re experiencing back pain and neurological symptoms, make sure to visit a trusted, highly-rated spinal specialist for a diagnosis. Additionally, consider receiving a second opinion to ensure that you receive a thorough, accurate evaluation.