Spondylolisthesis | Spondylolysis | Spondylisis

Spondylolisthesis | Spondylolysis | Spondylisis Fusion Alternatives

Ross Hauser, MD

When an injury, degenerative disc disease, or spinal ligament weakness causes spinal instability to the extent that the vertebrae are unable to maintain their proper position, a vertebra can slip out of place. This can occur on a single level or on multilevels of the spine.

The condition of “slipped disc” or “slipped vertebra,” is called by various names and diagnosis labels including degenerative Spondylolisthesis or under the more general term degenerative disc disease.

For the young athlete diagnosed with this condition please see spondylolisthesis in the athlete.

Many other terms for Spondylolisthesis: What does spondylosis and spondylitis mean?

Other terms are often used to describe the same symptoms of Spondylolisthesis. These are Spondylisis or spondylosis of the spine, what do they mean?

These are sometimes confusing terms that act as a catch all phrase or umbrella term to describe neurological or degenerative or inflammatory disorders caused by spinal defects which can occur in the cervical, thoracic, and lumbar regions. Spinal defects meaning stress fractures from wear and tear. This can also be called isthmic spondylolisthesis – a fracture of the pars interarticularis; a bone which connects the upper and lower facet joints.

The terms can also be linked to degrees of severity such as mild or moderate or advanced spondylisis or severe spondylisis that can cause local or diffuse pain. Sometimes everything is just thrown into one term spondylotic. It is sometimes difficult for the to understand all these definitions.

One problem is when the problem is difficult to understand – patients opt for surgery.

 


Spondylolisthesis grading

http://radiopaedia.org- http://goo.gl/9vBeCz

Spondyloliosthesis grading is based on amount of “slippage”

Typically grades 1 and 2 are treated successfully with Prolotherapy injections see below.

Unilateral vs. Bilateral Spondylolysis?

In new research, doctors at the Joanna Briggs Institute, Faculty of Health Sciences, The University of Adelaide, South Australia compared surgical versus non-surgical treatments for Spondylolisthesis.3

Historically, spondylolysis injuries were thought to be mostly bilateral (both sides of vertebrae) ; however advances in lumbar spine imaging have shown that in certain athlete groups, unilateral spondylolysis is highly prevalent.

Here is another term to describe what is going on in the back. In the Spondylolysis patient. as mentioned above) a defect in the segment of bone joining the facet joints of the spine is called the  pars interarticularis defect (pars fracture) and it can be on one side of the spine (unilateral) or both sides (bilateral). You can also add anterior spondylolisthesis, a fracture towards the back of the vertebrae.

In the study, the doctors examined previously published papers researching athletes with symptomatic unilateral spondylolysis of the lumbar spine who had spondylolisthesis surgery which attempted a direct repair of the pars interarticularis, compared to conservative management.

What they were really looking for was what got the athlete back to the sport quickly. The effectiveness of surgery on pain and overall function were secondary outcomes of interest.

Five studies reporting results for the outcomes of interest were critically appraised and included in the review. The limited evidence on the effectiveness of surgical treatment versus conservative treatment for unilateral spondylolysis in athletes does not allow any conclusions to be drawn about the relative effectiveness of surgery versus conservative treatment for facilitating rapid return to sport or a high level of post injury sporting level/performance.

It does suggest, however, that for adult athletes for whom conservative treatment has not been successful, surgery is likely to enable return to sport, reduce pain and promote overall function.

Prolotherapy for spondylolisthesis – from a diseased to healing environment

 

Understanding how to determine and even treat or prevent worsening spondyloarthritis is discussed by Italy’s University of Foggia Medical School researchers. In their study in the Annals of Medicine the Italian researchers say: Despite intensive research in spondyloarthritis pathogenesis, some important questions still remain unanswered, particularly concerning enthesis new bone formation (this is the formation of bone spurs in the spine).

Several studies suggest that spondyloarthritis pathogenesis prevalently occurs by endochondral ossification (a process of bone growth involving the cartilage), however it remains to identify factors that can induce and influence its initiation and progression.

Back to the research: The University of Foggia team has hypothesized that several systemic factors (adipokines – cell signalling proteins secreted by fat tissue that help mediate inflammation) and (gut hormones – gastrointestinal hormones that impact what fat cells do) and local factors (BMP Bone Morphogenetic Proteins that stimulate bone growth) and (Wnt signaling – stem cell signalling) as well as angiogenesis (blood vessel formation) and mechanical stress are involved.

I discuss these topics at length in my articles: Stem cell therapy effective in halting and reversing degenerative disc disease,  How stem cells heal degenerative joint disease after years of cortisone and painkillers.

The researchers end their paper bay saying: Complete understanding of spondyloarthritis pathophysiology requires insights into inflammation, bone destruction and bone formation, which are all located in entheses and lead all together to ankylosis (fusion) and functional disability.4

In other words this is a diseased spine environment.

Comprehensive Prolotherapy which includes the use of stem cell therapy can be an ideal treatment for patient with developing spondylolisthesis because it strengthens the ligaments and tendon enthesis surrounding and attached to the slipped vertebrae. As the ligaments and tendons are strengthened spinal stability is restored.

Treatments are given to the ligaments on the back of the spine.  By tightening the ligaments in the back of the spine Prolotherapy helps stabilize the area thereby giving pain relief and allowing for other structures to heal. Typically a patient will require 3-6 visits, although some patients require more visits depending on their overall health status and the extent of their injury.

References for this article.

3. Scheepers MS, Streak Gomersall J, Munn Z. The effectiveness of surgical versus conservative treatment for symptomatic unilateral spondylolysis of the lumbar spine in athletes: a systematic review. JBI Database System Rev Implement Rep. 2015 Apr 17;13(3):137-73. doi: 10.11124/jbisrir-2015-1926 [Pubmed] [Google Scholar

4. Neve A, Maruotti N, Corrado A, Cantatore FP. Pathogenesis of ligaments ossification in spondyloarthritis: insights and doubts. Ann Med. 2017 May;49(3):196-205. [Pubmed]

 

 

 

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