Degenerative Spondylolisthesis

Degenerative Spondylolisthesis

Degenerative spondylolisthesis is Latin for "slipped vertebral body," and it is diagnosed when one vertebra slips forward over the one below it. This condition occurs as a consequence of the general aging process in which the bones, joints, and ligaments in the spine become weak and less able to hold the spinal column in alignment.

Degenerative spondylolisthesis is more common in people over age 50, and far more common in individuals older than 65. It is also more common in females than males by a 3:1 margin.

A degenerative spondylolisthesis typically occurs at one of two levels of the lumbar spine:

Degenerative spondylolisthesis is relatively rare at other levels of the spine, but may occur at two levels or even three levels simultaneously. While not as common as lumbar spondylolisthesis, cervical spondylolisthesis (in the neck) can occur. When degenerative spondylolisthesis does occur in the neck, it is usually a secondary issue to arthritis in the facet joints.

This article reviews the underlying causes, diagnosis, symptoms, and full range of surgical and non-surgical treatment options for degenerative spondylolisthesis.

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Degenerative Spondylolisthesis Causes

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 restrain motion. 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.

Degenerative Spondylolisthesis Diagnosis

Degenerative spondylolisthesis is diagnosed by a spine specialist through a 3-step process:

  • Medical History – primarily a review of the patient’s symptoms and what makes the symptoms better or worse.
  • Physical Examination – the patient is examined for physical symptoms, such as range of motion, flexibility, any muscle weakness or neurological symptoms.
  • Diagnostic Tests – if a spondylolisthesis is suspected after the medical history and physical exam, an X-ray may be done to confirm the diagnosis and/or rule out other possible causes of the patient’s symptoms. Based on the results of the X-ray, further tests may be ordered, such as an MRI scan, to gain additional insights.

Unlike isthmic spondylolisthesis, the degree of the slip of a degenerative spondylolisthesis is typically not graded as it is almost always a grade 1 or 2.

In cases of degenerative spondylolisthesis, the degenerated facet joints tend to increase in size, and enlarged facet joints then encroach upon the spinal canal that runs down the middle of the spinal column, causing lumbar spinal stenosis.

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Article written by: Peter F. Ullrich, Jr., MD