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Spondylolisthesis occurs when one vertebra slips forward on the one below. This narrows the spinal canal - the tube-like structure that contains the spinal cord and spinal nerves.
Spondylolisthesis usually occurs in the lumbar spine. The narrowing of the spinal canal results in compression of the spinal nerve roots, which causes in pain in the back and legs. Spondylolisthesis can be minor or quite severe if the vertebrae above slips far forward on the one below. More commonly, the slippage occurs in older patients due to degeneration of the supporting structures of the spine.
The symptoms of spondylolisthesis are usually back pain and leg pain with walking, although some patients will have back and/or leg pain with rest. Pain in the legs exacerbated by walking and relieved by rest is very typical of spinal stenosis pain.
The patient's medical history and physical exam combined with an MRI and/or CT will confirm the diagnosis and help with the decision-making process of how to approach treatment. X-rays may show the slippage moving with views taken in flexion and extension.
Mild spondylolisthesis that does not result in severe symptoms may be followed over time. If surgery is necessary, minimally invasive techniques are used to open the space for the spinal nerves and fuse the spine to prevent it from slipping more.
The minimally invasive TLIF (transforamial lumbar interbody fusion) is an excellent technique to reduce the slippage and open the space for the nerves. A fusion involves uniting the slipped vertebrae together with a variety of different bone substitutes. Many of the same techniques used to treat spinal stenosis are also used to treat spondylolisthesis.
In the lumbar spine, the surgery consists of relieving the pressure on the spinal nerves and can now be done by minimally invasive techniques. The X lift procedure increases the space for the nerves through a minimally invasive surgery performed from the side of the spine. In other situations, a laminectomy with removal of bone and ligament to make room may be a better choice. The removal of the compression results in relief of the symptoms.