This condition usually affects the lumbosacral joint, which is the fifth lumbar vertebra of the sacrum (the large triangular bone at the end of the spine). In rare cases, it can affect other areas of the spine. Children, young adults, and older adults can be affected. The severity of spondylolisthesis is classified as Grade 1, 2, 3 or 4. Basically, what happens is that the 5th lumbar vertebra slides forward over the sacrum. Depending on how much the forward slip is, determine the slope.
Causes can be sudden severe trauma, a fracture of part of the bone, or degeneration of the spinal joint or disc. Trauma, such as a sudden and severe stretching of the lower spine that can occur in weight lifting, gymnastics, basketball, soccer, or any sport that places increased stress on the lower back. Spondylolisthesis due to trauma is usually found in younger adults because they are more prone to more sports activities, where there is body contact of a violent nature. Degenerative spondylolisthesis will occur in older adults, especially if they are involved in work where heavy lifting and bending are required, and they also participate in strenuous sports. Anything that exposes them to sudden, acute stress on the lower back can lead to spondylolisthesis. Disc pathological conditions, such as disc degeneration, wear, and rupture, can cause hypermobility of the fifth lumbar vertebra, causing it to slide forward over the sacrum.
With all of the above causes of spondylolisthesis, lax back and abdominal muscles due to a sedentary lifestyle may be the most important causative factor. Loss of necessary muscle support predisposes the individual to spinal trauma.
As the population aged 50 and over increases, more cases of spondylolisthesis will be seen due to degenerative changes. An increase of about 10% to 25% is not only likely, but also certain. This increase is due to older people working longer before retirement and increased sports activities such as running, bowling, golf, tennis, etc. Other causes can be attributed to a congenital defect that affects the joint of the 5th lumbar vertebra and / or the sacrum. Being 20 pounds or more overweight will aggravate the injury, and not having the necessary muscular support puts the individual at risk.
Spondylolisthesis can be an extremely painful condition that causes a variety of symptoms and long-term disability. Symptoms can be severe and cause low back pain, with pain that can also radiate to the groin, buttocks, and lower extremities. In men, pain in the groin most likely affects the testicle. There may also be neurological symptoms, such as numbness and tingling that affect the leg. These symptoms are due to a decrease in the size of the foramen (opening) through which the spinal nerve exits the spine. This narrowing of the opening causes the nerve to be pinched, which irritates the nerve and establishes radiating pain syndrome. The side on which the nerve is pinched will determine the side of pain. In men, testicular pain will be reflected in the testicle on the side of the pinched nerve and can be sharp pain or neuralgia.
If these symptoms occur after a traumatic event, the person should see their chiropractor or doctor to diagnose and evaluate the condition. Once the diagnosis and evaluation have been made, they will determine the course of treatment. Depending on the severity of the condition, especially if there is a fracture, the treatment of choice would be immobilization of the lumbosacral area with an orthopedic hip belt. Complete rest is also indicated. The belt should be worn for at least 3 months, but during this time, physical therapy and conservative chiropractic care can help relieve pain and muscle spasms. During very severe painful episodes, the person may want to sleep with the belt on, but must take it off for a few hours during the day when the person is at rest. In rare cases, when the vertebra has been severely fractured, surgical intervention may be necessary.
In the elderly patient, where the onset of symptoms has been gradual over a period of years, they must also be diagnosed and evaluated and appropriate treatment initiated. Getting treatment does not prevent the person with spondylolisthesis from helping himself. Institution of a home self-care program can prevent further deterioration of your condition. If they are grade 1, they can prevent a progression to grade 2, and so on. Preventing this progression will also prevent the more serious symptoms from occurring, saving the individual from some very painful episodes.
The home program should consist of hot showers, morning and evening, letting the shower hit your back for 5 to 10 minutes at a time. Using an analgesic gel applied 3 to 4 times a day in the lumbosacral area will calm and relieve some of the pain. A massage of the lumbar muscles and the buttocks will help reduce muscle spasms. During this period of self-care they should also wear the orthopedic hip belt during the day, and if necessary during sleep hours. If you are not at work or at rest, remove your belt for several hours during the day as mentioned above.
If the person must return to work, extreme caution should be exercised so as not to aggravate the condition by excess. This means that they should take all precautions, not bending over too much or lifting anything that weighs more than 5 pounds. Anyone who is overweight should try to lose excess weight. An obese person with a large abdomen puts more pressure on the lumbosacral area by helping gravity pull on the already stressed spine. They must make a concerted effort to lose this weight, because of their condition and their overall health.
After a treatment regimen is started as described above, the individual should respond in approximately 2 to 3 months. If the answer is not favorable, they should be reevaluated. However, following your doctor’s advice and concentrated effort at home will likely prevent this and result in a full recovery. Now, during all of this self-care, the individual should begin an exercise program as soon as they can begin to move freely without pain. The exercise program will strengthen your abdominal and back muscles. It is these muscles that play such an important role in supporting the spine. The ideal program for strengthening and as a preventive is the “Exercise of the Senior Doctor” program. It’s a no-impact total body workout that is done at home and only takes 15-20 minutes. Starting your program is just the first step. Dedicating yourself to continuing the program on a daily basis is your second step, and that will determine the results and how you will feel and how you will enjoy life.