What is Spondylolisthesis?

Spondylolisthesis is defined as the movement of adjacent vertebra relative to each other.

Although spondylolisthesis can be caused by many pathologic entities, degenerative spondylolisthesis is by far the most common. With aging, discs lose water content and ultimately height. As the vertebra on either side of the disc come closer to each other through the loss of disc height, the upper vertebra slides forward on the subadjacent vertebra producing spondylolisthesis. High stresses and motion produce degeneration of the disc and for this reason the most susceptible levels of the lumbar spine, L4-L5, followed by L3-L4 and L5-S1 are the vertebral segments most commonly involved.

Spondylolisthesis is also associated with deterioration of the facet joints connecting the two vertebra. As the facet joints become arthritic due to this deterioration, they enlarge in an attempt to confer stability. As the two rings of the vertebral segments which make up the spinal canal, slide past each other, the canal narrows in size . The combination of canal narrowing and enlargement of the facet joints, produces the characteristic nerve compression problems found in degenerative spondylolisthesis. The nerves are compressed in two major areas at the site of a degenerative spondylolisthesis. It is believed that a reduction in nerve blood flow accounts for the symptoms produced from spinal canal narrowing (Spinal stenosis).

That in a nutshell is what spondy is. Once again I feel good knowing that I am not average and have to be different. My spondy is at the L5/S1, which according to this passage is not the most prevalent spot! However my Spondy was brought about by Spondylolysis which is described below.

The most common X-ray identified cause of low back pain in adolescent athletes is a stress fracture in one of the bones (vertebrae) that make up the spinal column. Technically, this condition is called spondylolysis (spon-dee-low-lye-sis). It usually affects the fifth lumbar vertebra in the lower back, and much less commonly, the fourth lumbar vertebra.

If the stress fracture weakens the bone so much that it is unable to maintain its proper position, the vertebra can start to shift out of place. This condition is called spondylolisthesis (spon-dee-low-lis-thee-sis). If too much slippage occurs, the bones may begin to press on nerves and surgery may be necessary to correct the condition.

Basically it is a broken bone that allows the vertebra to move freely about. I was originally diagnosed in 2002 with this and spent several months doing physical therapy and pain management to control it. My job however required heavy lifting daily and usually in excess of 100lbs (about 45kilos) and upwards of 170lbs (about 77kilos) and no matter how much PT I was doing the stress put on my back ended up being to much. Sad thing is it was a kick ass job and I was the guy in charge of the whole operation.

So what happened? In the end the damage the lumbar spine was actually not so bad, I was only a grade II spondy but I was having a lot of trouble with the nerves that run from the L5. They were being compressed by the disk which in turn was causing shooting pain down the left leg as well as numbness. From time to time I would also have what is known as a "flair up" in which the muscles in the lower back became so over worked they would start to spasm. That would put you down for a couple of days with pain meds and muscle relaxers. I consulted with a neurosurgeon for several months who I must say was one of the most professional docs I have ever met. He helped me understand a lot of what was going on and mapped out a treatment plan for me that included all the possible outcomes and how we would treat X if Y happened. Due to the nerve compression though we decided to move forward and have the surgery done before the damage was permanent.