Spondylolisthesis (or Slipped Disc)

Spondylolisthesis (a slipped disc) may resemble sciatica or spinal stenosis. A second opinion will ensure you receive the right treatment.


Slipped Disc: An Overview

Our body’s center of gravity lays well in front of our lumbar spine.  As a result, the vertebrae of the lumbar spine experience mechanical shear stresses that make each individual vertebra want to slip forward and rotate into flexion around our center of gravity located within the sacrum.

This slippage of the vertebra is referred to as spondylolisthesis.

In a normal spine, the posterior lumbar facet joints (those paired joints in the back of the spinal column that connect one vertebra to the next) are typically oriented to resist the forward slippage of one vertebra relative to the next.  The resultant anterior shear forces, when combined with natural lumbar disc degeneration, can result in progressive slippage of one vertebra relative to the next.

This slippage of the vertebra is referred to as spondylolisthesis.

What Causes a Slipped Disc?

Many causes for spondylolisthesis exist.  First, congenital anomalies of the lower lumbar spine can result in malformed or suboptimally oriented lumbar facet joints incapable of resisting the shear stress that results in slippage of one vertebra relative to the next.  lumbar spine

Alternatively, a bony defect within the posterior bony arch connecting one vertebra to the next can exist (called a spondylolysis or pars defect).  This is the most common form of spondylolisthesis, and can arise as the result of trauma, repetitive loading leading to a stress fracture, or congenital defect in the bony arch itself.

Perhaps the most commonly seen cause of spondylolisthesis in individuals over the age of 40 is that of degenerative spondylolisthesis.  In this case, progressive degenerative disc disease with associated loss of disc height and associated age-related degenerative changes in the facet joints in the back of the spine contribute to a progressively unstable relationship between adjacent vertebrae, resulting in forward displacement of one vertebra relative to another.

Degenerative spondylolisthesis is five times more frequent in women than in men and usually occurs after age 40.  The L4-5 interspace is six to ten times more frequently involved than adjacent levels.

Slipped Disc Symptoms

As a result of forward slippage of one vertebra upon another, two pain patterns may result.  First, an individual may experience an activity-related achiness and fatigue-like pain across the low back and buttocks, extending toward the thighs or calves, depending on the level of stenosis.  The symptoms of such spinal stenosis are usually relieved by sitting or changing to a forward-flexed position. spinal cord and nerves

The other common pattern of pain is that of typical sciatica.  The primary site of nerve compression is typically within the L4-5 level resulting in nerve compression, or a pinched nerve, between L4 and L5.  Pain is usually slow in onset, but, typically, it will progress over a span of months to years.

Slipped Disc Treatment

As long periods of remission are not uncommon, conservative care is highly preferable to surgery.  Such care may include:

  • Rest or immobilization
  • Abdominal strengthening
  • Anti-inflammatory medications
  • Oral or injected steroids


Second Opinions for Slipped Discs

If your doctor has recommended surgery for a slipped disc, you should seek a second opinion.  


First, you want to ensure all non-surgical options have been assessed and ruled out.  As noted above, most cases of a slipped disc go into remission after conservative–non-surgical care–has been pursued.

Even if surgical stabilization is necessary, a second opinion will give you peace of mind that all non-operative treatments have been seriously considered.

Second, you want to ensure the diagnosis is correct.  Spondylolisthesis may result in symptoms similar to sciatica and spinal stenosis.  By confirming the diagnosis, you can ensure you receive the right treatment.

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