Back pain is tricky. It can have many different causes and can pop up unexpectedly at any time of life. A few conditions that sound similar and all can cause back pain are- spondylolysis, spondylosis, and spondylolisthesis. Though they have a similar meaning, these three terms differ greatly from each other. The first term spondylosis means arthritis. It can affect the spine, particularly the back and neck. The second term is spondylolysis, which occurs when the spine or one of the vertebrae of the lower back experiences a stress fracture. Athletes are prone to this condition. The third term is spondylolisthesis, where a vertebra in the back fractures and slips forward. This can touch the vertebra underneath. All three of these conditions can cause severe pain in your back. 

Who is at risk for spondylolisthesis?

Spondylolisthesis occurs in approximately 4 – 6% of adults, which is not a large number, but the key word is “adults”. The following factors increase your risk of developing spondylolisthesis:

• Athletes: Children who engage in sports involving the lumbar spine, such as gymnastics and football, are more likely to develop spondylolisthesis. Growth spurts tend to cause vertebral slippage in children. 
• Genetics: Some people are born with a thinner section of the vertebrae. The thinner sections of the vertebrae are more prone to fracture and slip. 
• Age: People with spinal conditions are at an increased risk of developing spondylolisthesis after the age of 50.
• Gender: Women are more likely than men to suffer from spondylolisthesis, regardless of their age or sports participation.

Types of spondylolisthesis include:

• Congenital spondylolisthesis: results from misaligned vertebrae in the spine of a newborn. 
• Traumatic spondylolisthesis: results from vertebrae slipping due to an injury.
• Isthmic spondylolisthesis happens as a result of spondylolysis. 
• Post-surgical spondylolisthesis results from slippage in the spine following surgery.
• Degenerative spondylolisthesis, the most common type, occurs as a result of aging. During aging, the discs between our bones, the ones that cushion them, get thinner and dry out, which makes the bones more prone to slipping forward.
• Pathological spondylolisthesis occurs when a disease or tumor causes the condition.

Classification of spondylolisthesis

There are five levels of spondylolisthesis, and the severity increases with each level.

• Grade I – 1 to 25% forward slippage 
• Grade II – up to 50% of forward slippage
• Grade III- up to 75% of forward slippage
• Grade IV – 76 to 100% of forward slippage
• Grade V is greater than 100% slippage

In some cases, an individual’s pain is so severe that surgery is required to relieve the discomfort. 

It is possible for a spondylolisthesis to be completely asymptomatic for years. If you do experience symptoms, lower back pain will be the main one. The pain may spread to the buttocks and down the thighs. You may also experience muscle spasm of the hamstrings, stiffness to the back, difficulty with long walking or long-standing, pain with flexion or bending and numbness or tingling or weakness of the foot. 

How is spondylolisthesis diagnosed? 

Diagnostics of spondylolisthesis are made by physical examination, which is preceded by a detailed history of the patient’s symptoms. It is imperative that history be taken carefully. People who suffer from back pain, especially if it’s severe and lingering, should seek medical attention in order to find out what is causing it. As part of helping to diagnose someone with spondylolisthesis, imaging tests are also performed. X-rays could be used to examine the location of the bones. When a person or a clinician wants more information, then they will order a CT scan or MRI, because that will give them more visual information. 

Conservative treatment for spondylolisthesis include: 

1. Rest from the offending activity. So if you are a gymnast, then unfortunately, you should take a break from doing gymnastics. If you play football, you should take a break from football.  
2. Over the counter medication
3. Steroid injection to the painful area
4. Wearing a back brace. 
5. Physiotherapy. This would include among several things, exercises that are specifically to strengthen the core muscles. 

Ways to prevent  spondylolisthesis: 

1. Exercise
2. Maintain a healthy weight. Extra weight puts a lot of stress on your joints and that includes the joints that are in your back. 
3. Eat well to keep your bones nourished and strong.

If you are experiencing back pain that lasts more than a few days and/or is unbearable, please seek the assistance of a licensed medical professional. 

Disclaimer: This blog article is not to be taken as medical advice. Please seek out care from a licensed health care professional before making any changes to your diet or exercise regimen, or make sure to speak with your primary care physician.