Spondylolisthesis Treatment and Management

If you are suffering from pain due to spondylolisthesis, training and experience must rank high on your list when choosing a physician to correctly diagnose and treat your condition. With over 8 years of experience, our caring, highly qualified, and skilled ABMS Board Certified and ACGME fellowship trained Interventional Pain Doctor can help.


Spondylolisthesis Definition

Spondylolisthesis is derived from the Greek word spondylous for vertebra, and olisthesis meaning to slip or slide down a slippery incline. Spondylolisthesis narrows the spinal canal and symptoms of spinal stenosis are common. An individual suffering from spondylolisthesis will typically experience generalized pain in the lower back, along with intermittent shocks of shooting pain beginning in the buttock traveling downward into the back of the thigh and/or lower leg. Sciatica that extends below the knee and may be felt in the feet. Sometimes symptoms include tingling and numbness. Sitting and trying to stand up may be painful and difficult. Coughing and sneezing can intensify the pain. Typical physical changes that occur in an individual with spondylolisthesis will be a general stiffening of the back and a tightening of the hamstrings, with a resulting change in both posture and gait. Spondylolisthesis is officially categorized into five different types by the Wiltse classification system: Dysplastic, Isthmic, Degenerative, Traumatic, and Pathologic. – Wikipedia

Types of Spondylolisthesis

Dysplastic Spondylolisthes is a true congenital spondylolisthesis that occurs because of malformation of the lumbosacral junction with small, incompetent facet joints. Dysplastic spondylolisthesis is very rare, but tends to progress rapidly, and is often associated with more severe neurological deficits. It is difficult to treat because the posterior elements and transverse processes tend to be poorly developed, leaving little surface area for a posterolateral fusion.

Isthmic Spondylolisthesis is the most common form of spondylolisthesis. Isthmic spondylolisthesis (also called spondylolytic spondylolisthesis) is a common condition with a reported prevalence of 5%-7% in the U.S. population. The spondylolytic defect is usually acquired between the ages of 6 and 16 years, and that the slip often occurs shortly thereafter. Once the slip has occurred, it rarely continues to progress, although one study did find an association between disc desiccation and slip progression during middle age. It is thought that the vast majority of isthmic slips do not become symptomatic, but the incidence of symptoms is unknown.

Degenerative Spondylolisthesis is a disease of the older adult that develops as a result of facet arthritis and facet remodeling. As the facets remodel, they take on a more sagittal orientation, allowing a mild slip to occur. These slips are very common: a study of osteoporosis found a 30% incidence among Caucasian women older than 65 years and a 60% incidence among African-American women older than 65 years. Most slips are asymptomatic but can worsen the symptoms of neurogenic claudication when associated with lumbar spinal stenosis. Degenerative spondylolisthesis with spinal stenosis is one of the most common indications for spine surgery among older adults, and current evidence suggests that patients have much better success rates and more clinical benefit with decompression and fusion than with decompression alone.

Traumatic Spondylolisthesis is very rare and may be associated with acute fracture of the inferior facets or pars interarticularis. It is treated in the same manner as are other spinal fractures, and there are only a handful of case reports on this type.

Pathologic Spondylolisthesis is the last type and is also very rare. This type can occur following damage to the posterior elements from metastases or metabolic bone disease. These slips have been reported in cases of Paget’s disease of bone, tuberculosis, giant-cell tumors, and tumor metastases.

Spondylolisthesis Specialists
We offer the entire spectrum of state-of-the-art minimally invasive spine and pain management procedures to diagnose and treat back and neck pain, headache, RSD, joint pain, nerve pain, and many other types of pain.

Our mission is to provide up to date, evidence-based, and individualized care for our patients in a comfortable private office setting. Through a comprehensive multidisciplinary approach, we strive to relieve your pain, improve function and maximize your quality of life. We hope to be the answer to your pain. We offer unparalleled service, are easily accessible, and work closely with local community healthcare providers.

Our Boston, Massachusetts-area and Cape Cod area chronic pain clinics are located in Dedham, Duxbury, Wellesley, West Yarmouth, and Mashpee.