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Sondylo– Vertebral bone, Listhesis– Slipping over
Spondylolisthesis is defined as slipping of one vertebral body over the othercasuing compression of the surrounding neural structures and thus symptoms. The cause of this pathology is multifactorial however, degenerative spondylolisthesis and spondylolytic spondylolisthesis are most commonly seen.
In Degenerative conditions, the slipping occurs due to age related wear and tear. It is commonly seen in females of 5th and 6th decades. L4-5 is the most commonly affected level.
In Spondylolyticpathology, there is an inborn or early developmental weakness in one of the parts of vertebral body known as ‘pars’. Though present since many years, patients become symptomatic in fifth/ sixth decades. Females are more affected than males and L5-S1 is the most common pathological level.
Symptoms and overall management of both types of spondylolisthesis is usually similar. Patients complain of mechanical low back pain. This pain is aggravated on sitting, standing and changing positions. They also complain of radiating pain to lower limbs and/or paraesthesia. They feel heaviness in legs on walking.
In extreme cases, there may be neurological weakness for which urgent surgery is warranted. X-rays usually are diagnostic of the pathology with dynamic films [flexion and extension] demonstrating mobility. MRI is asked to look for compression of neurological structures and to assess the status of remaining soft tissues. Many patients have symptomatic relief with lumbar belts/ corsets, medications and physiotherapy.
When conservative treatment fails to provide adequate relief- surgical management is advised. Surgery involves decompression of neural structures and stabilization of mobile vertebral bodies along with safe correction of forward slippage. This is known as Lumbar Decompression and Stabilization Surgery which can be done with Conventional/ Open or Minimally Invasive Surgical Techniques. The approach used is usually from the back [Posterior TLIF/PLIF] or from the front i.e. abdomen [Anterior ALIF/ Oblique OLIF/ Lateral XLIF].