SPONDYLOLYSTHESIS

Spondylolysthesis is a condition in the low back that often leads to chronic lumbar pain and sometimes leg pain. There are two causes:

1. TYPE 1: A stress fracture between the facet joints

2. TYPE 2: Degenerative wear and tear of the facets, changing the shape and orientation of the facets.

Both types allow the vertebra to slide forwards on its nearest neighbour below.

What is a FACET?

• Superior facet

• Inferior facet

Between the two facets lies the crucial weak area, the so-called 'pars'. Its full name is pars interarticularis, a narrow isthmus of bone that links the two articular facets.

Notice the powerful secure mechanism in the graphic below as the inferior facet of the vertebra of L4 locks neatly into the superior facet of L5. It's quite impossible for L4 to slide forwards on L5. Unless there's a fracture in the pars of L5.

Type I: Pars fracture Spondylolysthesis

SCOTTY DOG

Can you spot the so-called "Scotty Dog"? If Scotty has a collar, then there is a defect. The defect itself is called a SPONDYLOLYSIS. It takes two 'Lysis', one on each side, to allow the vertebra to slide forward, the SPONDYLOLYSTHESIS.

Pars interarticularis

"inter-articularis" = between the articulating facets.

Can you see the crack in the pars in the graphic above? Current opinion is that in childhood, when the pars is still made of cartilage, a heavy fall, or something ... it's almost never recalled, a fracture through BOTH pars interarticularises allows one vertebra to slide forward on that below.

Type 2: Degenerative spondylolysthesis

CHIROPRACTIC

In my experience, all of thirty years, the problem is often not at the spondylolysthesis, but at one of the adjoining joints. Either in one of the Sacro-iliac joints, or at the level above or below the spondylolysthesis. In this case, at L4-L5.

Spondylolysthesis is never cured, and must come under management by your chiropractor. I recommend an occasional, but regular, consultation. Daily exercises are essential, and an acceptance that playing silly buggers should have no place in the lifestyle of a person with a spondylo. Lifting pianos, heavy gardening and perhaps worst of all long periods of sitting do not belong in the life of person with a spondylolysthesis.

FROM THE COAL FACE

Mr B, a 35 year old builder had Right low back pain for 10 years. In January 2008 it became severe, and radiated into the buttock, thigh, side of the lower leg and foot (pain, tingling and numb). He had to stay home for three months under physiotherapy.

Mr P consulted me in October 2008, still with severe pain in the buttock and right leg. Nonchalant walking, standing and sitting remained problematic.

His medical insurance was totally taken up with physiotherapy, but we agreed to a trial of 5 treatments. There was some progress. I didn't see him again for three months during which time he progressively improved, coming in for another five treatments. Yesterday he told me he has no problem whatsoever.

Diagnosis:

1. Sacro-iliac tests were strongly positive.

2. Stable spondylolysthesis.

Treatment: 10 chiropractic treatments over a period of 8 months.

He is very faithful with his exercises and now comes every two months for an adjustment of his sacro-iliac joint.

In the x-ray above you can clearly see the crack through the pars.

Coalface 2

Ten years ago she suddenly developed severe leg pain bilaterally, and was wrongly diagnosed with dystrophy in the lower legs by a neurologist. She clearly has a serious spondylo with forward slippage, serious loss of disc height at L5-S1 and lumbar stenosis. Severe muscle weakness soon developed in both calves - she was at 52 unable to lift either heel from the ground. She was soon only able to walk with the aid of a walker. At the time, I would have recommended decompression surgery, not something I readily suggest, but it clearly should have been done. It wasn't.

Walking remained very difficult. Four years ago, because of the weakness in her lower legs, she had nasty fall resulting in the severe herniation at L2-L3. Misery, with severe pain down the side of the right leg.

Notice the 'modic effect'. Deep bone pain caused by fluid that has seeped into the bone.

I won't pretend there have been miraculous changes. She still uses the walker, and the strength in her calves will never return. But the pain in her back is much reduced, she has almost no pain down the side of the leg, and she can sit without pain. She comes every six weeks now for 'control' as we call it in Holland. We're both very pleased obviously.

My point? This is a case where surgery was indicated ten years ago. It's too late now - the damage to the nerves to the lower legs is permanent.

Once your back pain has lasted more than six months, the definition of "chronic", the chances that your back pain will never entirely go away increases. "Living with back pain" becomes an increasingly a reality. Learning to help yourself is always important. More exercises ... More back pain treatments.

LINKS