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Thoracic Spondylosis

Spondylosis is a medical term that refers to a degenerative condition affecting the spine.  It is a common condition that occurs because of wear and tear in the spine, typically due to aging or injury.  Spondylosis can affect any part of the spine. 

What is Thoracic Spondylosis?

The thoracic spine, also known as the mid back, is that portion of the spine that is below the cervical spine (neck) and above the lumbar spine (low back). Thoracic spondylosis is a degenerative condition of the thoracic spine.

The thoracic spine, also known as the mid back, is composed of many important different structures that work together to provide stability and movement.

The major components include:

• Vertebrae : 12 boney building blocks that stack one upon another.
• Thoracic Disc : 12 fibrocartilaginous cushions sandwiched between the vertebrae that act as shock absorbers.
• Thoracic Joints : 3 important joints:  thoracic facets, thoracic costotransverse and costovertebral
• Thoracic Muscles :  three principal layers: superficial, intermediate and deep muscles.
• Thoracic Ligaments :  multiple dense bands of connective tissue that hold bones together. Think of them as duct tape for the body.
• Thoracic Nerves :  Multiple nerves that are responsible for sending and receiving signals from the muscles, skin, and organs in the chest and upper abdomen.

Causes And Risk Factors Of Thoracic Spondylosis

Thoracic spondylosis is a degenerative condition affecting the middle region of the spine, known as the thoracic spine.  The major causes include:

With age, there is a generalized wear and tear on the thoracic spine.  The discs lose their water content and become less flexible.  They also tend to become smaller in size which can lead to the development of bone spurs , nerve root irritation, facet joint arthritis , and ligament laxity (1).

Some people may be more prone to developing thoracic spondylosis due to genetic factors.

Poor Posture

Poor posture for extended periods can cause excessive stress on the thoracic vertebrae, discs, facet joints, and ligaments and can lead to the development of thoracic spondylosis.

Repetitive Strain

Activities that involve repetitive movement or heavy lifting can cause wear and tear on the spine, leading to spondylosis.

Trauma to the spine, such as a fall or car accident, can cause damage to the thoracic disc, facet joints, and ligaments and this can lead to spondylosis (2).

Symptoms Of Spondylosis Of The Thoracic

Thoracic spondylosis is a degenerative condition that affects the thoracic spine.  Symptoms can be mild, moderate, or severe depending upon the location and severity of degenerative changes. The most common symptoms associated with thoracic spondylosis include:

One of the major symptoms of spondylosis of the thoracic spine is mid back pain.  The pain can be intermittent or constant.  It can be isolated to one side or may involve both sides of the spine.  

The severity of the pain is dependent upon many factors that include the location and severity of the degenerative changes. The back pain can be dull and throbbing or electrical and stabbing. It may be localized along the spine or can radiate across the chest wall or into the abdomen.

Stiffness is common in patients with thoracic spondylosis as the disc’s lose their water content and ability to act as shock absorbers. The forces of daily living are then transferred to the vertebrae bodies, posterior facet joints, and supporting ligaments. The resulting pressure and inflammation can cause symptoms like pain, stiffness, and restricted range of motion.

Tingling or numbness

Tingling and numbness are common symptoms associated with thoracic spondylosis. The thoracic discs can become injured with a loss in disc height or disc protrusions.  Disc injuries in turn can cause compression of the nerves in the thoracic spine, leading to a sensation of tingling and numbness in the affected area. 

 As the condition progresses, the numbness may spread to other parts of the body, such as the arms, legs, and hands.  In severe cases, thoracic spondylosis can also lead to muscle weakness, loss of balance, and difficulty walking.

Back Pain in Ribs

Experiencing thoracic spine and rib pain? Learn more about what could be causing this and the treatment options that can provide lasting relief. Back pain in the ribs can be a common and often debilitating condition, causing discomfort and limiting mobility for many individuals. The pain can range from mild to severe and may be caused by various underlying conditions. Understanding the many causes of rib and back pain is important and can assist in securing an accurate diagnosis. Treatment options vary depending on the underlying cause and severity of symptoms.

Big Toe Numbness

Believe it or not, one of those significant issues that can present as numbness stems from the low back. In the lumbar spine, the nerve that exits the spine at the L5 level branches down through the hip, thigh, knee, lower leg, and, yes, all the way into the foot and toes. So a pinched or irritated nerve at that L5 level in the back can create problems, such as pain, numbness, tingling, and so on, anywhere along the nerve branch. So what can irritate the L5 spinal nerve? The list is long, but it includes disc issues, such as herniated…

Leg Feels Disconnected

So what exactly causes the leg to feel disconnected? The hip joint is the connection point between the leg and the rest of the body. The femur in the leg and the acetabulum in the pelvis create the hip joint. So if the left SI joint, for example, in the back and the symphysis pubis joint in the front becomes unstable due to loose supporting ligaments, then the left leg, which is connected between the two joints, is likely to also feel a bit disconnected. Likewise, if the right SI joint were unstable, then the right leg might feel disconnected. How This Patient’s “Disconnected” Leg Was Fixed Despite “leg feels…

Leg Gives Out

Have you ever been walking and your leg gives out? It can be both surprising and alarming What would cause your leg to give out? Can sciatica cause your leg to give out? How do you treat weak legs? Let’s dig in.Weakness in the leg can arise from three principal sources: nerve problems, muscle weakness, and SI joint dysfunction. Weakness in the legs may indicate a significant nerve problem. In many cases, it may be the first indication of a nerve problem. There are three common causes of nerve injury: low back disorders, nerve compression as it descends down into the hip, thigh, and shin and medical conditions such as diabetes…

Lower Back Pain When Sitting

After a long day on your feet sitting down is supposed to be way to relaxing. Unfortunately for some sitting for any length of time can be painful. Most people experience low back pain at some point in their life. The lifetime prevalence of low back pain is 85% (1). Let’s take a deeper look at the different types of pain and causes of low back pain when sitting. Pain can present in many different ways. It can be intermitent or constant. The quality of the low back pain can also vary depending upon the actual source of injury. Common examples include: Sharp and Stabbing, Dull and Aching, Throbbing/ Pulsating, Pins and Needles, Burning, Electrical

Lower Back Pain When Standing

When you’re seated, the facet joints in your lower back are in an open and slightly flexed position. When you stand up, these joints compress. If they are painful or have arthritis, you’ll have pain as you stand up because this puts pressure on the painful joints. In addition, if there is any type of movement of one vertebra forward on another (called spondylolisthesis), then this shift will have occurred as you sit. This is called degenerative spondylolisthesis. When you get back up, the vertebrae will come back into position after a few seconds, leading to that awkward “walk it out period” that starts out painful and ends up more normal.

Nerve Pain in the Thoracic Spine

The thoracic spine is the part of the spine below the neck (cervical spine) and above the low back (lumbar spine). It is often referred to as the mid back. Nerves exit the thoracic spine at each level and can become irritated, compressed or injured, resulting in pain and dysfunction. This is commonly referred to as thoracic radiculopathy or pinched nerve.

Referred Pain From The Thoracic Spine

Pain is the body’s way of signaling distress or injury. But what if your body manifests pain in a certain area of your body and yet the actual source of the discomfort is a completely different part of your body? In this article, we will explore the intricacies of referred pain, specifically referred pain from the thoracic spine. We’ll explore what this typically feels like, what conditions commonly cause referred pain, and the treatment options available to treat the root cause of this symptom.

Diagnosis Of Thoracic Spondylosis

The diagnosis of thoracic spondylosis usually involves a combination of medical history, physical examination, and radiographic imaging tests.

Important questions during the medical history include onset of symptoms, triggering events, location of pain, numbness and tingling, aggravating factors and alleviating factors. Other important questions include past medical and surgical history and current medications.

During physical examination the doctor will evaluate a patient’s range of motion, muscle strength, reflexes, and sensation to light touch and pin prick. 

Imaging tests are most often used to confirm the diagnosis for thoracic spondylosis. Thoracic x-rays are beneficial as they are widely available, low cost, with little radiation exposure.  X-rays provide detailed images of the bony structures of the spine and can identify bone spurs, fractures, and injury to the disc.

Unfortunately, they do not provide detailed information on the discs, facet joint, ligaments, tendons, nerves, or the spinal cord. 

MRI is the gold standard in the diagnosis of thoracic spondylosis (3).  MRI uses a powerful magnetic field and radio waves to produce detailed images of the body.  Thoracic MRI clearly details the spinal cord, spinal nerves, discs, ligaments, and tendons and can detect both large and small abnormalities. 

Common Treatment Options

Thoracic spondylosis is a degenerative condition that affects the thoracic spine. It can cause pain, stiffness, restricted range of motion, and numbness and tingling in the extremities.  Treatment options include conservative therapy, medications, injections and in severe cases possibly surgery. When appropriate, the first line of treatment should be conservative care. 

The best treatment option depends on many factors which include the severity of the spondylosis, a patient’s symptoms, past medical condition, current medications and access to treatment.  The most common treatment options include:

The other day I was evaluating a patient and reviewing the treatment options for their spine condition.  After discussing prior treatments, we got to the topic of medications taken for pain relief. She explained that she mainly utilized anti-inflammatory (NSAID) medications and then she told me to hold much she takes and has been for many years…..she takes close to 2 grams (2000 milligrams) on a daily basis which equated to about 9-10 capsules of medication per day.  I was shocked, considering she was pre-diabetic and with high blood pressure plus the kicker of it is that her PCP (primary care physician) is ok with this…

Thoracic Spine Surgery

Thoracic spine surgery is a major surgery aimed at treating injuries in the thoracic spine. Because of the complex anatomy and close proximity to the heart and lungs, there are significant surgical risks and complications. Surgery on the thoracic spine can take hours and may require deflating the lung in order to gain access to the thoracic injury. Recovery can be lengthy depending upon the specific thoracic spine surgery performed. There are several different types of thoracic spine surgery.  The specific thoracic spine performed depends upon the underlying thoracic injury and a symptoms of the patient.  For example, a thoracic disc herniation…

Patients that fail to get significant or sustained benefit from conservative care, medications, and steroid injections are often referred for surgical consultation. Surgery should be the last option given the significant complications and complex anatomy. The exception are those patients with progressive neurologic deficits such as weakness, numbness, or tingling in the arms or legs. 

Surgery may also be considered in cases of spinal instability that are threatening an individual’s quality of life. The most common surgeries include thoracic laminectomy, thoracic discectomy, and fusion.  All are major surgeries with significant and potentially permanent complications which have been discussed in a previous blog.

Regenerative Options For Thoracic Spondylosis

At the Centeno-Schultz Clinic , regenerative treatment options are available for the treatment of thoracic spine injuries including thoracic spondylosis. Regenerative treatment options utilize the healing potential of your body’s own cells. 

Treatment options include bone marrow concentrate, prolotherapy and PRP.  All injections are customized and performed under ultrasound or x-ray guidance.  Regenerative treatment options allow patients to forgo the toxicity of steroids, the potential dependence of medications, and complications of surgery. 

Bone Marrow Aspirate Concentrate

Bone marrow aspirate also known as Regenexx SD is a procedure in which bone marrow is harvested from a patient, processed in the state of art cell laboratory, and injected in the area of tissue damage.  Bone marrow concentrate contains stem cells.  

These repair cells live inside all of us and are poised to leap into action to repair damage as it occurs.  The bone marrow concentrate is customized for each patient in the lab as opposed to using the “one size fits all” approach commonly used by many stem cell clinics.

Prolotherapy Injections

It has been successful in the treatment of many disorders including neck, shoulder, knee, and ankle pain. Dr. Centeno recently published an article in The Journal of Prolotherapy in which he discusses the use of x-ray guidance with prolotherapy. This ensures that the injection is in the correct place to maximize clinical results. Dr. Centeno discusses the use of prolotherapy for the treatment of neck, knee, sacroiliac joint, ankle, ischial tuberosity, and shoulder pain. At the Centeno-Schultz Clinic x-ray guided prolotherapy is just one of the therapies utilized in the successful treatment of pain. Regenerative injection therapy (RIT) or prolotherapy…

PRP Injections

PRP is short for platelet-rich plasma, and it is autologous blood with concentrations of platelets above baseline values. The potential benefit of platelet-rich plasma has received considerable interest due to the appeal of a simple, safe, and minimally invasive method of applying growth factors. PRP treatments are a form of regenerative medicine that utilizes the blood healing factors to help the body repair itself by means of injecting PRP into the damaged tissue. In regenerative orthopedics, it is typically used for the treatment of muscle strains, tears, ligament and tendon tears, minor arthritis, and joint instability. There have been more than 30 randomized controlled trials of PRP…

Prolotherapy For Thoracic Pain

Prolotherapy is an injection based regenerative therapy used in the treatment of ligament, tendon, muscle and spine injuries. It is minimally invasive and involves the injection of an irritant such as dextrose into the damaged or painful area. The injected irritant stimulates a delayed or frozen healing cycle thereby increasing blood flow and tissue healing. The thoracic spine is that section of the spine that is below the neck and above the low back. It is also referred to as the mid back. It has multiple components that include: Vertebral Bodies: Boney building blocks that stack one upon another…

Experience The Centeno-Schultz Difference

Thoracic spondylosis is a degenerative condition of the thoracic spine.  It can affect the thoracic vertebrae, discs, thoracic joints, muscles, ligaments, nerves, and spinal cord. 

Major causes include aging, genetics, poor posture, repetitive sprain, and trauma.  Symptoms include pain, stiffness, restriction in range of motion, tingling, and numbness.

Diagnosis involves medical history, physical examination, and radiographic imaging tests. MRI is the gold standard as it allows for clear visualization of the discs, facet joints, ligaments, tendons, spinal cord, and nerves. 

Conservative care when appropriate should always be first line treatment. Other options include medications and steroid injections. Thoracic spine surgery is major surgery and associated with significant risks. It may be indicated in patients with progressive neurologic symptoms or instability.  

Regenerative treatments include bone marrow concentrate, prolotherapy, and PRP which allows patients to use their own healing cells and avoid the risks of steroids, medications, and potentially surgery.

At the Centeno-Schultz Clinic we are experts in the evaluation and treatment of thoracic spine injuries. Board certified, fellowship trained physicians can evaluate your candidacy for regenerative, non-surgical  treatment options.

Thoracic pain is poorly understood and oftentimes mismanaged.  Come to the experts and learn which regenerative treatments are best for you or a loved one. 

Thoracic Spine Physician and Expert

John Schultz, MD

John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate and PRP for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI).

Not sure what treatment path to follow? Consult us to get expert opinion on diagnosing your condition!

More Resources

Understanding the thoracic and lumbar spines.

The thoracic spine and lumbar spine make up a vital nexus of stability and mobility in the human body. In this exploration, we delve into the biomechanics and complexities that define these regions, unraveling their significance in posture, movement, and overall well-being.  Understanding the thoracic and lumbar spine not only illustrates the mechanics of our…

Understanding the Role Of The Thoracic Spine Muscles

The thoracic spine plays a critical role in the stability and mobility of the upper body. Comprised of twelve vertebrae and an intricate network of muscles and ligaments, it serves as a central pillar supporting the structure and movement of the body. Understanding the role and function of thoracic spine muscles is pivotal for anyone…

Degenerative Changes Of The Thoracic Spine

Degenerative changes of the thoracic spine involve the gradual loss of normal structure and function over time. There are several different causes which are discussed in detail below. The thoracic spine is composed of many different and important components that are susceptible, both to injury and generalized wear and tear. The degeneration can occur in…

The Ultimate Guide To Thoracic Spine Exercises

Thoracic spine exercises are important for several reasons. First, they can help improve thoracic mobility, reducing the risk of spinal injuries and improving posture. Second, they can help to strengthen the muscles of the upper back and shoulders. Finally, thoracic spine exercises can help improve breathing mechanics. What Is Thoracic Spine? The thoracic spine, also…

Where Is The Thoracic Spine?

The thoracic spine is a region of the spine that is located in the middle back.  It is located below the cervical spine and above the lumbar spine.  It is composed of 12 vertebrae that are numbered T1-12. The T denotes the thoracic spine. It has many important functions which are discussed below. Location Of The…

Symptoms of Thoracic Herniated Disc

Your mid back pain has been unrelenting since the accident.  Rest, medications, and physical therapy have failed to provide significant or sustained benefits.  Your doctor thinks you have a thoracic disc herniation and thinks you have a thoracic herniated disc. What are the symptoms? And what can you do? Let’s dig in. What Is A…

1.Lauerman, W. C., & Stetkarova, I. (2018). Age-related changes in the spine: a review of spinal pathology through the human life span. The American Journal of Orthopedics, 47(12).

2.Furlan, J. C., Catharine Craven, B., Fehlings, M. G., & Shannon, P. (2006). Spondylotic myelopathy: a clinical and radiological evaluation of the consequences of traumatic injury. Journal of Neurology, Neurosurgery & Psychiatry , 77(7), 944-947.

3.Ahn SH, Ahn MW, Byun WM. Effectiveness of magnetic resonance imaging in diagnosing thoracic myelopathy caused by thoracic spondylosis. Int Orthop. 2003;27(3):152-154. doi:10.1007/s00264-002-0402-9

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Spondylolisthesis

Spondylolisthesis is a displacement of a vertebra in which the bone slides out of its proper position onto the bone below it. Most often, this displacement occurs following a break or fracture.

Surgery may be necessary to correct the condition if too much movement occurs and the bones begin to press on nerves.

Other complications may include:

• Chronic back pain
• Sensation changes
• Weakness of the legs
• Temporary or permanent damage of spinal nerve roots
• Loss of bladder control

When a vertebra slips out of proper alignment, discs can be damaged. To surgically correct this condition, a spinal surgeon removes the damaged disc. The slipped vertebra is then brought back into line, relieving pressure on the spinal nerve.

Types of spondylolisthesis include:

• Dysplastic spondylolisthesis , caused by a defect in part of the vertebra
• Isthmic spondylolisthesis , may be caused by repetitive trauma and is more common in athletes exposed to hyperextension motions
• Degenerative spondylolisthesis , occurs with cartilage degeneration because of arthritic changes in the joints
• Traumatic spondylolisthesis , caused by a fracture of the pedicle, lamina or facet joints as a result of direct trauma or injury to the vertebrae
• Pathologic spondylolisthesis , caused by a bone defect or abnormality, such as a tumor

Symptoms may vary from mild to severe. In some cases, there may be no symptoms at all.

Spondylolisthesis can lead to increased lordosis (also called swayback), and in later stages may result in kyphosis, or round back, as the upper spine falls off the lower.

Symptoms may include:

• Lower back pain
• Muscle tightness (tight hamstring muscle)
• Pain, numbness or tingling in the thighs and buttocks
• Tenderness in the area of the vertebra that is out of place
• Weakness in the legs
• Stiffness, causing changes in posture and gait
• A semi-kyphotic posture (leaning forward)
• A waddling gate in advanced cases
• Lower-back pain along the sciatic nerve
• Changes in bladder function

Spondylolisthesis may also produce a slipping sensation when moving into an upright position and pain when sitting and trying to stand.

Spondylolisthesis may appear in children as the result of a birth defect or sudden injury, typically occurring between the fifth bone in the lower back (lumbar vertebra) and the first bone in the sacrum (pelvis).

In adults, spondylolisthesis is the result of abnormal wear on the cartilage and bones from conditions such as arthritis , trauma from an accident or injury, or the result of a fracture, tumor or bone abnormality.

Sports that place a great deal of stress on bones may cause additional deterioration, fractures and bone disease, which may cause the bones of the spine to become weak and shift out of place.

A simple X-ray of the back will show any cracks, fractures or vertebrae slippage that are the signs of spondylolisthesis.

A CT scan or an MRI may be used to further diagnose the extent of the damage and possible treatments.

Treatment for spondylolisthesis will depend on the severity of the vertebra shift. Stretching and exercise may improve some cases as back muscles strengthen.

Non-invasive treatments include:

• Heat/Ice application
• Pain medicine (Tylenol and/or NSAIDS)
• Physical therapy
• Epidural injections

Surgery may be needed to fuse the shifted vertebrae if the patient has:

• Severe pain that does not get better with treatment
• A severe shift of a spine bone
• Weakness of muscles in a leg or both legs

Surgical process realigns the vertebrae, fixing them in place with a small rod that is attached with a pedicle screw, adding stability to the spine with or without the addition to an interbody (bone graft or cage) placed between the vertebra from the side or front.

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Spondylolisthesis

• Diagnosis |
• Treatment |

Spondylolisthesis is partial displacement of a bone in the lower back.

Injuries or a degenerative condition can cause this disorder.

Pain is felt in the low back and may travel down one or both legs.

The diagnosis is based on the results of imaging tests.

Treatment includes measures to relieve pain.

The spine (spinal column) consists of back bones (vertebrae) stacked one on top of another. In lumbar spondylolisthesis, a vertebrae in the lower back slips forward. This disorder usually occurs during adolescence or young adulthood (often in athletes). It is usually caused by a birth defect or an injury that causes fractures (breaks) in a part of the vertebra. If both sides of the vertebra are involved, the vertebra can then slip forward over the one below it. Spondylolisthesis can also occur in older adults, mainly as the result of degeneration of the discs between the vertebrae or osteoarthritis . People who develop spondylolisthesis as adults are at risk of developing lumbar spinal stenosis .

Symptoms of Spondylolisthesis

Mild to moderate spondylolisthesis may cause little or no pain, particularly in young people.

When pain occurs in adolescents, it is felt on only one side of the spine and may travel down a leg. The pain may accompany a fracture.

When pain occurs in adults, it is felt over a specific part of the spine and travels down both legs. In these cases, the pain results from a degenerative condition.

Pain is worsened by standing or leaning back. It can be accompanied by numbness, weakness, or both in the legs.

Diagnosis of Spondylolisthesis

Imaging tests

Doctors base the diagnosis of spondylolisthesis on imaging tests, usually x-rays taken of the lower spine.

Other imaging tests, such as magnetic resonance imaging (MRI) or sometimes computed tomography (CT), may be done.

Treatment of Spondylolisthesis

Measures to relieve pain and stabilize the spine

One to two days of bed rest may provide pain relief for people with spondylolisthesis. Longer bed rest weakens the core muscles and increases stiffness, thus worsening back pain and prolonging recovery. Sleeping in a comfortable position on a medium mattress is recommended. People who sleep on their back can place a pillow under their knees. People who sleep on their side should use a pillow to support their head in a neutral position (not tilted down toward the bed or up toward the ceiling). They should place another pillow between their knees with their hips and knees bent slightly if that relieves their back pain. People can continue to sleep on their stomach if they are comfortable doing so.

Applying cold (such as ice packs) or heat

Physical therapy and exercises to strengthen and stretch the muscles in the abdomen, buttocks, and back (the core muscles) may help. (See also Low Back Pain: Prevention .)

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Spondylolisthesis.

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Last Update: May 22, 2023 .

• Continuing Education Activity

Spondylolisthesis is a condition that occurs when one vertebral body slips with respect to the adjacent vertebral body causing radicular or mechanical symptoms or pain. It is graded based on the degree of slippage of one vertebral body on the adjacent vertebral body. Any pathological process that can weaken the supports keeping vertebral bodies aligned can allow spondylolisthesis to occur. This activity illustrates the evaluation and management of spondylolisthesis and reviews the role of the interprofessional team in improving care for patients with this condition.

• Describe the pathophysiology of spondylolisthesis.
• Review the workup of a patient with spondylolisthesis.
• Summarize the treatment options for spondylolisthesis.
• Describee the importance of collaboration and communication among the interprofessional team in encouraging weight loss in patients to reduce symptoms and increase the quality of life in those with spondylolisthesis.
• Introduction

Spondylolisthesis is the slippage of one vertebral body with respect to the adjacent vertebral body causing mechanical or radicular symptoms or pain. It can be due to congenital, acquired, or idiopathic causes. Spondylolisthesis is graded based on the degree of slippage of one vertebral body on the adjacent vertebral body. [1]

Spondylolisthesis commonly classifies as one of five major etiologies: degenerative, isthmic, traumatic, dysplastic, or pathologic. Degenerative spondylolisthesis occurs from degenerative changes in the spine without any defect in the pars interarticularis. It is usually related to the combined facet joint and disc degeneration leading to instability and forward movement of one vertebral body relative to the adjacent vertebral body. Isthmic spondylolisthesis results from defects in the pars interarticularis. The cause of isthmic spondylolisthesis is undetermined, but a possible etiology includes microtrauma in adolescence related to sports such as wrestling, football, and gymnastics, where repeated lumbar extension occurs. Traumatic spondylolisthesis occurs after fractures of the pars interarticularis or the facet joint structure and is most common after trauma. Dysplastic spondylolisthesis is congenital and secondary to variation in the orientation of the facet joints to an abnormal alignment.  In dysplastic spondylolisthesis, the facet joints are more sagittally oriented than the typical coronal orientation. Pathologic spondylolisthesis can be from systemic causes such as bone or connective tissue disorders or a focal process, including infection, neoplasm, or iatrogenic origin. Additional risk factors for spondylolisthesis include a first-degree relative with spondylolisthesis, scoliosis, or occult spina bifida at the S1 level. [1]

• Epidemiology

Spondylolisthesis most commonly occurs in the lower lumbar spine but can also occur in the cervical spine and rarely, except for trauma, in the thoracic spine. Degenerative spondylolisthesis predominately occurs in adults and is more common in females than males with increased risk in the obese. Isthmic spondylolisthesis is more common in the adolescent and young adult population but may go unrecognized until symptoms develop in adulthood. There is a higher prevalence of isthmic spondylolisthesis in males. Dysplastic spondylolisthesis is more common in the pediatric population, with females more commonly affected than males. Current estimates for prevalence are 6 to 7% for isthmic spondylolisthesis by the age of 18 years, and up to 18% of adult patients undergoing MRI of the lumbar spine. Grade I spondylolisthesis accounts for 75% of all cases. Spondylolisthesis most commonly occurs at the L5-S1 level with an anterior translation of the L5 vertebral body on the S1 vertebral body. The L4-5 level is the second most common location for spondylolisthesis. 

• Pathophysiology

Any process that can weaken the supports keeping vertebral bodies aligned can allow spondylolisthesis to occur. As one vertebra moves relative to the adjacent vertebrae, local pain can occur from mechanical motion or radicular or myelopathic pain can occur due to compression of the exiting nerve roots or spinal cord, respectively. Pediatric patients are more likely to increase spondylolisthesis grade when going through puberty. Older patients with lower grades I or II spondylolistheses are less likely to progress to higher grades over time.

• History and Physical

Patients typically have intermittent and localized low back pain for lumbar spondylolisthesis and localized neck pain for cervical spondylolisthesis. The pain is exacerbated by flexing and extending at the affected segment, as this can cause mechanic pain from motion. Pain may be exacerbated by direct palpation of the affected segment. Pain can also be radicular in nature as the exiting nerve roots become compressed due to the narrowing of nerve foramina as one vertebra slips on the adjacent vertebrae, the traversing nerve root (root to the level below) can also be impinged through associated lateral recess narrowing, disc protrusion, or central stenosis. Pain can sometimes improve in certain positions such as lying supine. This improvement is due to the instability of the spondylolisthesis that reduces with supine posture, thus relieving the pressure on the bony elements as well as opening the spinal canal or neural foramen. Other symptoms associated with lumbar spondylolisthesis include buttock pain, numbness, or weakness in the leg(s), difficulty walking, and rarely loss of bowel or bladder control.

Anteroposterior and lateral plain films, as well as lateral flexion-extension plain films, are the standard for the initial diagnosis of spondylolisthesis. One is looking for the abnormal alignment of one vertebral body to the next as well as possible motion with flexion and extension, which would indicate instability. In isthmic spondylolisthesis, there may be a pars defect, which is termed the "Scotty dog collar." The "Scotty dog collar" shows a hyperdensity where the collar would be on the cartoon dog, which represents the fracture of the pars interarticularis. Computed tomography (CT) of the spine provides the highest sensitivity and specificity for diagnosing spondylolisthesis. Spondylolisthesis can be better appreciated on sagittal reconstructions as compared to axial CT imaging. MRI of the spine can show associated soft tissue and disc abnormalities, but it is relatively more challenging to appreciate bony detail and a potential pars defect on MRI. [2] [3]

• Treatment / Management

For grade I and II spondylolisthesis, treatment typically begins with conservative therapy, including nonsteroidal anti-inflammatory drugs (NSAIDs), heat, light exercise, traction, bracing, and/or bed rest. Approximately 10% to 15% of younger patients with low-grade spondylolisthesis will fail conservative treatment and need surgical treatment. No definitive standards exist for surgical treatment. Surgical treatment includes a varying combination of decompression, fusion with or without instrumentation, or interbody fusion. Patients with instability are more likely to require operative intervention.  Some surgeons recommend a reduction of the spondylolisthesis if able as this not only decreases foraminal narrowing but also can improve spinopelvic sagittal alignment and decrease the risk for further degenerative spinal changes in the future. The reduction can be more difficult and riskier in higher grades and impacted spondylolisthesis. [4] [5] [6] [7] [8] [2] [9] [10]

• Differential Diagnosis
• Degenerative  Lumbar Disc Disease
• Lumbar Disc Problems
• Lumbosacral Disc Injuries
• Lumbosacral Discogenic Pain Syndrome
• Lumbosacral Facet Syndrome
• Lumbosacral Radiculopathy
• Lumbosacral Spine Acute Bony Injuries
• Lumbosacral Spondylosis
• Myofascial Pain in Athletes
• Pearls and Other Issues

Meyerding’s classification of spondylolisthesis is the most commonly used grading method. Its basis is on the percentage of anterior translation relative to the adjacent level. Grade I spondylolisthesis is 1 to 25% slippage, grade II is up to 50% slippage, grade III is up to 75% slippage, and grade IV is 76-100% slippage. If there is more than 100% slippage, it is known as spondyloptosis or grade V spondylolisthesis.  

Subclasses of isthmic spondylolisthesis are subtype A (stress fractures of the pars), subtype B (elongation of the pars without overt fracture), subtype C (acute fracture of the pars).

Subclasses of pathologic spondylolisthesis are subtype A (systemic causes) and subtype B (focal processes).

• Enhancing Healthcare Team Outcomes

An interprofessional team consisting of a specialty-trained orthopedic nurse, a physical therapist, and an orthopedic surgeon or neurosurgeon will provide the best outcome and long-term care of patients with degenerative spondylolisthesis. Chiropractors may also have involvement, as they may be the first to encounter the condition on X-rays. The treating clinician will decide on the management plan, and then have the other team members engaged - surgical cases with include the nursing staff in pre-, intra-, and post-operative care, and coordinating with PT for rehabilitation. In non-operative cases, the PT will keep the rest of the team informed of progress or lack thereof. The team should encourage weight loss as weight reduction may reduce symptoms and increase the quality of life. Interprofessional collaboration, as above, will drive patient outcomes to their best results. [Level 5]

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Lumbar Spine Sagittal CT of L5-S1, Grade II Spondylolisthesis Contributed by Christopher Gillis, MD, and Steven Tenny, MD

Disclosure: Steven Tenny declares no relevant financial relationships with ineligible companies.

Disclosure: Andrew Hanna declares no relevant financial relationships with ineligible companies.

Disclosure: Christopher Gillis declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Tenny S, Hanna A, Gillis CC. Spondylolisthesis. [Updated 2023 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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• Isthmic Spondylolisthesis. [StatPearls. 2024] Isthmic Spondylolisthesis. Burton MR, Dowling TJ, Mesfin FB. StatPearls. 2024 Jan
• High-grade slippage of the lumbar spine in a rat model of spondylolisthesis: effects of cyclooxygenase-2 inhibitor on its deformity. [Spine (Phila Pa 1976). 2006] High-grade slippage of the lumbar spine in a rat model of spondylolisthesis: effects of cyclooxygenase-2 inhibitor on its deformity. Komatsubara S, Sairyo K, Katoh S, Sakamaki T, Higashino K, Yasui N. Spine (Phila Pa 1976). 2006 Jul 15; 31(16):E528-34.
• [Three vertebral reduction and fixation for revision of lumbar spondylolisthesis]. [Zhongguo Gu Shang. 2014] [Three vertebral reduction and fixation for revision of lumbar spondylolisthesis]. Li CS. Zhongguo Gu Shang. 2014 Sep; 27(9):717-21.
• Review A review of the pathomechanism of forward slippage in pediatric spondylolysis: the Tokushima theory of growth plate slippage. [J Med Invest. 2015] Review A review of the pathomechanism of forward slippage in pediatric spondylolysis: the Tokushima theory of growth plate slippage. Sairyo K, Nagamachi A, Matsuura T, Higashino K, Sakai T, Suzue N, Hamada D, Takata Y, Goto T, Nishisho T, et al. J Med Invest. 2015; 62(1-2):11-8.
• Review Spondylolisthesis. [Orthop Rev (Pavia). 2022] Review Spondylolisthesis. Li N, Scofield J, Mangham P, Cooper J, Sherman W, Kaye A. Orthop Rev (Pavia). 2022; 14(4):36917. Epub 2022 Jul 27.

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Spondylolisthesis

UNDERSTANDING THE SYMPTOMS, CAUSES AND TREATMENTS

Understanding Spondylolisthesis

Spondylolisthesis is a medical diagnosis to describe the forward slippage of one vertebral body in relation to the vertebra below. The spine is made of several motion segments stacked on top of one another to allow for smooth movement in all directions. Each of these segments has three major points of contact including two facet joints and an intervertebral disc. If the facet joint and intervertebral discs degenerate or experience trauma this could lead to abnormal motion and misalignment. Another common cause of spondylolisthesis often diagnosed and treated by the specialists at VSI is a stress fracture in the vertebra.

Symptoms of spondylolisthesis depend on the severity of slippage. Symptoms can include pain, discomfort, stiffness, or muscle spasms in the low back. Symptoms of radiculopathy may appear including numbness, tingling, pain, or weakness in the legs. If the slippage is severe and causes detrimental pressure on the spinal nerves, you may develop symptoms of cauda equina syndrome. These include numbness in the groin area or down the legs, loss of bowel or bladder control, urinary urgency, or difficulty with balance or walking. Cauda equina is a spinal emergency and if you are experiencing these symptoms seek immediate evaluation.

When to Seek Treatment

If you’re noticing symptoms associated with Spondylolisthesis and suspect a spinal issue, it’s crucial to consider consulting a board-certified spinal specialist. Reach out promptly to a certified spine surgeon for an accurate diagnosis and timely treatment. Early intervention can significantly improve your overall well-being and provide a broader range of treatment options, which may decrease as symptoms persist. The key to a successful and speedy recovery lies in addressing the root of the pain with your spine specialist as soon as symptoms arise.

While many people experience day-to-day back or neck pain, dismissing it as soreness, this may not be the case for everyone. If your pain persists for more than 10 days, it should be taken more seriously. Evaluate such prolonged pain with a spine surgeon to identify the root issue and determine the appropriate treatment. Additionally, be attentive to other signs related to back or neck pain that should not be ignored, including pain accompanied by fever, pain associated with loss of bladder control, and weakness/tingling/numbness in your arms or legs.

It’s important to note that these are general guidelines based on our expertise in spine care over the past three decades, recognizing that each patient’s symptoms may be unique.

Common Causes

The spine is made up of bones, discs, soft tissues, and nerves. There are 7 cervical, 12 thoracic, and 5 lumbar vertebral bodies to make up the spinal column. Each of these vertebral bodies is stacked one on top of another. Between the vertebral bodies are intervertebral discs which act as the shock absorbers of the spine which naturally degenerate as we age. There are two different types of spondylolisthesis: degenerative and isthmic.

A pars fracture also known as spondylolysis is a fracture of the pars interarticularis. Isthmic spondylolisthesis is the medical term for slippage due to this type of fracture. In non-medical terms, this means the fracture caused instability, and over time the vertebral body slipped forward. This type of fracture may be the result of direct trauma or from a genetic weakness in this area of the bone and commonly occurs in adolescence.

Degenerative spondylolisthesis is caused by arthritic changes to the facet joints or degeneration of the intervertebral disc. With degenerative disc disease, intervertebral discs progressively break down. The discs lose hydration, there’s a decrease in disc height and function. They are no longer able to provide good structural stability. Recall facet joints are part of the three-joint complex stabilizing the spine. As the facet joints degenerate small ligaments supporting the joint wear down and loosen. This laxity allows the joint to separate more often contributing to a slippage or spondylolisthesis.

Diagnosing Spondylolisthesis

To properly diagnose a spondylolisthesis, weight-bearing x-rays are required. Typical imaging studies include AP, lateral, flexion, and extension lumbar views. These vital imaging studies allow your spinal specialists not only to diagnose a spondylolisthesis but also to grade the severity of this slippage. There are 5 different grades of spondylolisthesis and the higher the grade the increased risk of neurologic symptoms.

Treatment Options

There are many different treatment options for spondylolisthesis depending on the severity of the patient’s symptoms and the degree of slippage. Often, non-operative treatments are started initially. These include spine-specialized physical therapy, core strengthening, manual massage, dry needling, low-impact exercise, and maintaining an overall healthy lifestyle.

If patients fail non-operative treatment or are developing worsening neurologic symptoms, surgery is often discussed. There are many different approaches for surgical intervention which your spinal specialist at VSI will discuss with you in detail. The goal of surgical intervention is to stabilize the spine, alleviate pressure from the nerves, and correct any structural deformity. Every surgical plan is personalized to our patients depending on his or her symptoms or spinal needs.

Frequently Asked Questions about Spondylolisthesis

Does a spondylolisthesis always cause pain.

No, often mild degrees of slippage are asymptomatic meaning they cause no pain. Often, patients do not realize they have a spondylolisthesis until x-ray imaging confirms this diagnosis. If the spondylolisthesis worsens over time patients are more likely to experience symptoms.

Does a Spondylolisthesis get worse over time?

Life is a degenerative process. It is normal for joints to become arthritic or discs to degenerate as we use our back. If you are diagnosed with spondylolisthesis, especially at a young age, this does tend to worsen over time. Therefore following up with your spinal specialist at VSI is important to continue monitoring your physical exam for any changes in strength or reflexes and x-ray imaging to assess for any progression of the spondylolisthesis.

What activities should I avoid doing if I have a Spondylolisthesis?

High impact activities that put the spine at risk for trauma should be avoided in someone with a Spondylolisthesis. Building strong abdominal core muscles and maintaining an active healthy lifestyle are extremely important to aid in the stability of your spine. Activities to avoid include extreme impact sports, heaving weight lifting, diving, gymnastics, etc. unless cleared by a medical practitioner.

Can a Spondylolisthesis be reversed without surgery?

No, unfortunately spondylolisthesis is a structural instability of the spine. Non-operative treatments such as physical therapy and building core muscle strength aid in the stability of your spine and can decrease symptoms but they cannot change the underlying structural issue.

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Spondylolisthesis

Spondylolisthesis is where one of the bones in your spine, called a vertebra, slips forward. It can be painful, but there are treatments that can help.

It may happen anywhere along the spine, but is most common in the lower back.

Check if you have spondylolisthesis

The main symptoms of spondylolisthesis include:

• pain in your lower back, often worse when standing or walking and relieved when sitting or bending forward
• pain spreading to your bottom or thighs
• tight hamstrings (the muscles in the back of your thighs)
• pain, numbness or tingling spreading from your lower back down 1 leg ( sciatica )

Spondylolisthesis does not always cause symptoms.

Spondylolisthesis is not the same as a slipped disc . This is when the tissue between the bones in your spine pushes out.

Non-urgent advice: See a GP if:

• you have lower back pain that does not go away after 3 to 4 weeks
• you have pain in your thighs or bottom that does not go away after 3 to 4 weeks
• you're finding it difficult to walk or stand up straight
• you're worried about the pain or you're struggling to cope
• you have pain, numbness and tingling down 1 leg for more than 3 or 4 weeks

What happens at your GP appointment

If you have symptoms of spondylolisthesis, the GP may examine your back.

They may also ask you to lie down and raise 1 leg straight up in the air. This is painful if you have tight hamstrings or sciatica caused by spondylolisthesis.

The GP may arrange an X-ray to see if a bone in your spine has slipped forward.

You may have other scans, such as an MRI scan , if you have pain, numbness or weakness in your legs.

Treatments for spondylolisthesis

Treatments for spondylolisthesis depend on the symptoms you have and how severe they are.

Common treatments include:

• avoiding activities that make symptoms worse, such as bending, lifting, athletics and gymnastics
• taking anti-inflammatory painkillers such as ibuprofen or stronger painkillers on prescription
• steroid injections in your back to relieve pain, numbness and tingling in your leg
• physiotherapy to strengthen and stretch the muscles in your lower back, tummy and legs

The GP may refer you to a physiotherapist, or you can refer yourself in some areas.

Waiting times for physiotherapy on the NHS can be long. You can also get it privately.

Surgery for spondylolisthesis

The GP may refer you to a specialist for back surgery if other treatments do not work.

Types of surgery include:

• spinal fusion – the slipped bone (vertebra) is joined to the bone below with metal rods, screws and a bone graft
• lumbar decompression – a procedure to relieve pressure on the compressed spinal nerves

The operation is done under general anaesthetic , which means you will not be awake.

Recovery from surgery can take several weeks, but if often improves many of the symptoms of spondylolisthesis.

Talk to your surgeon about the risks and benefits of spinal surgery.

Causes of spondylolisthesis

Spondylolisthesis can:

• happen as you get older – the bones of the spine can weaken with age
• run in families
• be caused by a tiny crack in a bone (stress fracture) – this is more common in athletes and gymnasts

Page last reviewed: 01 June 2022 Next review due: 01 June 2025

Spondylosis

• • Wear and tear on the joints and disks of the spine that cause neck and back pain and stiffness
• • Symptoms include neck or back pain, decreased flexibility and range of motion of back and neck
• • Treatment includes activity modification, medications, massage, compresses, physical therapy, spinal injections, surgery
• • Involves orthopaedics & rehabilitation, spine surgery, neurology, physical medicine & rehabilitation
• Spinal Osteoarthritis
• Neck Osteoarthritis, Cervical Spondylosis
• Spondylolisthesis
• Spondylolysis
• Spondyloarthropathy

What is spondylosis?

What causes spondylosis, what are the risk factors for spondylosis, what are the symptoms of spondylosis, how is spondylosis diagnosed, how is spondylosis treated, what is the outlook for people with spondylosis, what makes yale unique in its treatment of spondylosis.

Neck or back pain that develops as we age may be a sign of spondylosis, a degenerative condition that affects the spine. Spondylosis is a normal, age-related condition. In fact, an estimated 90% of adults aged 60 years or older have this condition. However, most people with spondylosis are generally asymptomatic and don’t experience significant pain or other issues related to these arthritic changes.  

As we age, the joints and disks of the spine may start to wear out, which can cause pain and stiffness in the neck and back. In addition, associated bone spurs and disk herniation can potentially lead to nerve compression in the spine, which can cause symptoms of pain, numbness, or weakness in the arms or legs.  

Spondylosis affects men and women equally, but it is more common in certain individuals, including athletes, people who do heavy physical labor for a living, and smokers.  

Even though spondylosis doesn’t necessarily cause symptoms, there are safe and effective treatment options available for patients who do experience pain or neurologic changes related to this degenerative condition.

Spondylosis refers to the development of age-related arthritis that affects the spine. More specifically, it involves a number of different degenerative issues that affect the disks and joints of the spine.   

For example, over time, disks may become dehydrated, losing height as a result. Thus, they provide less cushioning and can actually “crack,” which can lead to herniations. Similarly, the cartilage in the spine’s joints can wear down, resulting in the formation of bone spurs.   

These arthritic changes can not only cause pain in the neck and back but can also lead to a narrowing of the spinal canal (also known as stenosis), which may compress nerves. Individuals with spinal stenosis may have neurologic symptoms in their extremities, such as numbness, tingling, or weakness radiating into their arms or legs. In severe cases, it can even lead to loss of bladder or bowel control.  

It is important to remember that while spondylosis is essentially ubiquitous in the older population, not every patient will experience symptoms or require treatment for this disease.

The most common cause of spondylosis is the cumulative joint stress that occurs as people age. It predisposes them to osteoarthritis , a common form of arthritis typically associated with progressive “wear and tear” on joint cartilage.  

Spondylosis may also arise as a result of previous trauma to the spine. For instance, this condition is more likely to occur among patients who:

• Have had car accidents, falls, or other spinal injuries
• Play competitive sports
• Perform strenuous physical activity at work
• Have had a previous neck or back surgery

The risk factors for spondylosis include the following:

• Age 60 or older
• Osteoarthritis affecting other joints
• Physically demanding jobs that may require heavy lifting or bending
• High-level athletics
• Neck or back injury
• Previous spine surgery
• Physical inactivity

Many with spondylosis do not have pain or other neurologic issues. However, some people may experience symptoms that either occur briefly or severely—or develop gradually over time.  

Signs and symptoms of spondylosis may include:

• Neck or back pain that worsens when coughing or sneezing
• Decreased flexibility in and range of motion of the neck or back
• “Clicking” sounds from the spine
• Pain radiating from the neck or lower back into the arms or legs, respectively
• Numbness, tingling, or weakness in the arms or legs
• Unsteady gait
• Muscle spasms
• Bladder or bowel dysfunction (in severe cases)

An individual can be diagnosed with spondylosis after their doctor obtains a medical history, performs a physical exam, and reviews diagnostic tests. Your doctor may also use this information to rule out other conditions, such as muscle strains, fractures, and cancer.  

When providing your medical history, it is important to share any history of spinal injuries or previous surgeries. You should also mention how physically active you are and if you play (or have played) sports.  

During the physical exam, your doctor will likely observe your walking ability and assess the range of motion of your spine to determine if you have any pain or stiffness. Palpation of the neck and back can also help identify the location of any tenderness associated with spondylosis. Your neurologic function will also be evaluated, including your sensation, strength, and reflexes. Special tests may also be performed to check for any signs of nerve impingement (from a disk herniation, for example).  

Finally, imaging studies like X-rays, computed tomography (CT scan), and magnetic resonance imaging (MRI) may also be used to identify any arthritic changes in the spine. Lab tests may also be useful for ruling out more concerning diseases, such as an infection or cancer.

Different treatments are available to treat spondylosis, depending on the type and severity of symptoms.  

Treatments for milder spondylosis include:

• Activity modification , such as avoiding activities that cause pain
• Medications , such as non-steroidal anti-inflammatory drugs (NSAIDs), over-the-counter analgesics (acetaminophen, for example), and muscle relaxants
• Hot/cold compresses, massage, and traction
• Physical therapy , such as strengthening and flexibility exercises and ergonomic education
• Spinal injections , such as an epidural around nerves and facet joints

In more severe cases, surgery might be the best course of action. It may involve the following procedures:

• Decompression (laminectomy, discectomy) , which involves the removal of bone spurs, disk herniations, and arthritis to relieve compression of the nerves and address neurologic symptoms
• Fusion , which is the formation of bone across adjacent vertebral bodies to stabilize the spine and relieve pain

Fortunately, most individuals with spondylosis will not experience symptoms and may never even realize that they have arthritis in their spines. However, for those who experience pain or neurologic changes due to nerve compression, safe and effective treatments are available.

“Spondylosis is one of the most common spinal diseases we encounter; in my experience, most patients can be managed successfully with conservative measures,” says Yale orthopaedic surgeon Peter Whang, MD . “However, in instances where individuals continue to suffer from severe pain or develop neurologic symptoms, at Yale we have access to cutting-edge technologies and novel therapeutic interventions, including intraoperative navigation, robotic surgery, and minimally invasive procedures, so that we can treat patients in a safer and more effective manner, allowing them to recover from surgery more rapidly and resume their normal life activities.”

Neurology and Neurosurgery

• Spondylolisthesis: Individualized approach for optimal outcomes

March 27, 2021

High-grade spondylolisthesis has diverse etiologies and presentations, as well as multiple treatment options. Mayo Clinic spinal surgeons tailor treatment to the individual patient to maximize outcomes and avoid future revision surgery.

"We treat many patients who had surgery elsewhere that used inadequate sacral and pelvic fixation. Inadequate fixation leads to higher rates of failed fusion, which requires more-complex surgery to repair," says Jeremy L. Fogelson, M.D. , a neurosurgeon specializing in spine care at Mayo Clinic in Rochester, Minnesota. "When we perform an initial surgery for spondylolisthesis, we take a safe but aggressive approach to fixation if needed."

Treating complex curvature

Preoperative X-ray shows severe spinal curvature in a 30-year-old woman with high-grade congenital spondylolisthesis. She presented at Mayo Clinic with intractable back pain and leg pain, which did not resolve with nonoperative treatments.

Successful fusion

Postoperative X-ray shows treatment with a fusion from L4 to S1, including pelvic fixation with S2 alar-iliac screws, and fixation into L5 with S1 to L5 transdiscal screws. Her pain was resolved and the fusion successfully healed, with eventual removal of the iliac screws.

As a high-volume center, Mayo Clinic regularly sees children and adults with congenital or degenerative spondylolisthesis. Full-body electro-optical system (EOS) imaging, a low-radiation X-ray technology, is routinely used for diagnosis. Mayo Clinic, which has a long history of imaging expertise, was among the first centers in the United States to offer EOS .

" EOS allows us to evaluate the entire spine as well as whole-body and leg alignment," Dr. Fogelson says. "We can factor in all features — cervical spine misalignment, bent knees or hips, leg-length discrepancy — into our treatment plan."

If surgery is needed, Mayo Clinic bases the approach not on a surgeon's preference but on the patient's condition. "We are able to perform the fusion posteriorly, anteriorly or laterally, or in some combination, depending on the individual patient's needs," Dr. Fogelson says. Less invasive surgical techniques also can be used.

In addition to neurosurgeons, Mayo Clinic's spondylolisthesis care team includes specialists in neurology, physical medicine and rehabilitation, and pain medicine. "We work from the beginning of each case with our colleagues in those specialties, to make sure we've maximized any nonoperative treatment possibilities," Dr. Fogelson says.

If surgery is needed, Mayo Clinic's neurosurgeons and orthopedic surgeons routinely collaborate on complex spinal procedures. 3D spinal navigation can be used to guide the placement of spinal hardware, and intraoperative CT checks screw placement. All members of the care team have spinal deformity expertise, including nurses and anesthesiologists dedicated to caring for patients during complex spinal procedures.

Mayo Clinic also works to learn more about optimal surgical approaches to spondylolisthesis. Within the field of spinal surgery, iliac fixation has sometimes been avoided, due to concerns about screws loosening over time and eventually requiring surgical removal related to pain. To investigate one aspect of this issue, Mayo Clinic is participating in a multicenter clinical trial comparing the outcomes of patients having multilevel lumbar fusion with or without simultaneous sacroiliac joint fusion.

Postoperative rehabilitation is an important aspect of treatment. At Mayo Clinic, rehabilitation care is provided by specialists in pain medicine and in physical medicine and rehabilitation, as well as physical and occupational therapists who routinely work with people who have had spinal deformity surgery.

A commitment to rehabilitation, combined with skilled surgical techniques, allows for positive results from spondylolisthesis surgery. "People facing lumbar fixation surgery often worry about loss of motion in the spine and further disability," Dr. Fogelson says. "But once the pain generator is fixed, most patients gain function. Spinal fusion can have very good outcomes when performed well and for the right reasons."

For more information

SI-BONE Inc. SI Joint Stabilization in Long Fusion to the Pelvis (SILVIA). ClinicalTrials.gov.

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Spondylolisthesis of the thoracic spine. Case report

Affiliation.

• 1 Department of Orthopedic Surgery, Akita University School of Medicine, Akita, Japan. [email protected]
• PMID: 16703910
• DOI: 10.3171/spi.2006.4.5.415

The thoracic spine is stabilized in the anteroposterior direction by the rib cage and the facet joints. Spondylolisthesis of the thoracic spine is less common than that of the lumbar spine. The authors describe a rare case of thoracic spondylolisthesis in which the patient suffered back pain and myelopathy. The patient was a 44-year-old woman. Plain radiography revealed Grade I T11-12 spondylolisthesis. The pedicle-facet joint angle at T-11 was 118 degrees, greater than that of T-10 or T-12. Postmyelography computerized tomography scanning revealed posterior compression of the dural sac as well as enlargement of and degenerative changes in the facet joint at T-11. Magnetic resonance imaging showed anterior and posterior compression of the spinal cord at the level of the spondylolisthesis. To achieve posterior T10-12 decompression, the surgeons performed a laminectomy and posterolateral fusion in which a pedicle screw fixation system was placed. The patient's back pain disappeared immediately after the operation. The authors conclude that the enlargement of the pedicle-facet joint angle and the degenerative changes of the facet joint caused the thoracolumbar spondylolisthesis.

Publication types

• Case Reports
• Laminectomy
• Magnetic Resonance Imaging
• Myelography
• Postoperative Complications / diagnosis
• Spinal Cord Compression / diagnosis
• Spinal Cord Compression / surgery
• Spinal Fusion*
• Spondylolisthesis / diagnosis
• Spondylolisthesis / surgery*
• Thoracic Vertebrae / pathology
• Thoracic Vertebrae / surgery*
• Tomography, X-Ray Computed