SPINAL INSTABILITY
The Various Different Spinal Instability Symptoms
Spinal Instability, or the slippage of a vertebra, usually occurs in the lower back and can cause an array of symptoms. The clinical term for spinal instability is Spondylolisthesis. Spondylolisthesis symptoms can range from feeling nothing at all in a minor slippage to excruciating pain from a severe slippage. Symptoms include pain and tenderness at the site of the slippage, as well as pain, tenderness, muscle spasms, and stiffness that may radiate into the buttocks and lower extremities if the slipped vertebra makes contact with the spinal cord or a nerve root. Furthermore, Spondylolisthesis symptoms usually result in poor posture and generate a gait with a shorter stride that resembles waddling. Placing extra stress on the lower back or moving in a manner that causes the back to bend backwards may increase the severity of pain felt in the lower back.
How Does A Slipped Vertebra Cause These Symptoms?
The reason Spondylolisthesis, as well as a selection of other spinal conditions, causes symptoms to be felt elsewhere in the body is due to the composition of the spine itself. The spine is the hub of the central nervous system and is home to many nerve roots that travel throughout the body. When a vertebra slips forward (or backward), the spinal cord and the nerve roots can become constricted or irritated, in which case signals of pain, tenderness, and spasms will be sent along the path of the nerve to the nerve endings. People with Spondylolisthesis may also notice stiffness and decreased flexibility in the area of the slipped vertebra.
What Should You Do About These Symptoms?
If you have been experiencing Spondylolisthesis symptoms, see your doctor, and explain the symptoms in their entirety. Your doctor will give you a physical examination and test your range of motion and flexibility, as well as a test for any signs of nerve damage. Your doctor also will likely perform some medical imaging, such as a Vertebral Motion Analysis (VMA) or X-ray, to provide you with a proper diagnosis. If you are diagnosed with Spondylolisthesis, your doctor will help determine the severity of the condition and go over the treatment options available to you, which usually begin with nonsurgical remedies like rest, activity modification, medication, and the application of cold packs and heating pads.
Understanding a Lumbar Spondylolisthesis Diagnosis
When you receive a Spondylolisthesis diagnosis in the lumbar (lower) spine, your doctor will give you more information about which type of Spondylolisthesis you have been diagnosed with. The primary five types of lumbar Spondylolisthesis are dysplastic Spondylolisthesis, isthmic Spondylolisthesis, degenerative Spondylolisthesis, traumatic Spondylolisthesis, and pathologic Spondylolisthesis.
The specific causes of each type of Spondylolisthesis are:
Dysplastic Spondylolisthesis - Caused by a congenital birth defect in the last lumbar vertebra and/or the sacrum.
Isthmic Spondylolisthesis – Caused by a defect, such as a fracture, in the pars interarticularis (a part of a vertebra). If the pars interarticularis is fractured, but no slip is present, the condition is called spondylolysis. Isthmic Spondylolisthesis is often seen in athletes like football players and gymnasts who place a lot of stress on their lower backs.
Degenerative Spondylolisthesis – Caused by the natural aging process and arthritic changes in vertebrae, which result in cartilage degeneration and the inability of the spine to maintain its proper alignment.
Traumatic Spondylolisthesis – Caused by a traumatic injury to the vertebra, fracturing the pedicle, lamina, or facet joints.
Pathologic Spondylolisthesis – Caused by a bone disease in the vertebra, such as a tumor or Paget’s disease.
The Different Grades of Disc Slippage
In addition to Spondylolisthesis being typed, it is also graded on a scale of 1 to 5, with 1 being a minimal slip and 5 a complete slip. As part of your Spondylolisthesis diagnosis and medical imaging, the doctor can determine both the type and grade of Spondylolisthesis. A Grade 1 slippage means the vertebra has slipped 1 to 25 percent, Grade 2 means the vertebra has slipped 26 to 50 percent, Grade 3 means the vertebra has slipped 51 to 75 percent, Grade 4 means the vertebra has slipped 76 to 99 percent, and a Grade 5 slippage means the vertebra has slipped completely in front of the vertebra below it.
What Happens After the Spondylolisthesis Diagnosis?
After you are diagnosed with Spondylolisthesis, probably the first thing you’ll want to know is how to treat it. If your vertebral slippage is not too severe, your doctor will probably first suggest conservative (nonsurgical) treatment. Conservative treatment may include medication, stretching and exercise, physical therapy, and epidural steroid injections. Another form of conservative treatment is chiropractic care, as chiropractors can adjust the spine to slightly decrease the amount of vertebral slippage. If conservative and chiropractic treatments have been tried with little or no success, spine surgery may be considered as a treatment option.
Spondylolisthesis Treatment Methods May Vary Depending on Severity
The appropriate method of Spondylolisthesis treatment mainly depends on the severity of condition. Patients with a minute vertebral slip might not need any treatment at all, while immediate surgery might be the only method to improve the quality of life for a patient with a complete vertebral slip. Whether your Spondylolisthesis is a minimal, one percent “grade 1” slip or a full, 100 percent “grade 5” slip, it is vital to talk to your doctor and discuss the most appropriate treatment method for you.
Conservative and Chiropractic Treatment Methods
Spine surgery is a big step, and before suggesting surgery as a Spondylolisthesis treatment option, nearly all doctors will first suggest conservative (nonsurgical) treatment methods. The nonsurgical treatment methods that should be sought out first include physical therapy, behavior modification, pain medication and muscle relaxants, back bracing, and epidural steroid injections.
Some patients also might seek chiropractic care. Chiropractors specialize in conservative and alternative treatments for a variety of spinal conditions. For instance, chiropractors can use special blocks as fulcrums to push on the spine in such a way that the Spondylolisthesis may actually be reversed slightly. However, chiropractors generally cannot completely restore the spine to its natural state and cure all Spondylolisthesis symptoms.
Minimally Invasive Surgery as an Option of Spondylolisthesis Treatment
There are cases in which nonsurgical Spondylolisthesis treatment methods provide little or no relief to patients. In these circumstances, patients and their doctors may begin to discuss surgery as a viable treatment option. As a popular alternative to open spine surgery like spinal fusion, patients may elect a minimally invasive spine surgery. In minimally invasive surgeries, a small incision is cut in the back at the site of the Spondylolisthesis. Through the use of a small endoscope connected to a television monitor, a laser, and other surgical tools, surgeons are able to relieve nerve compression that is caused by a slipped vertebra. Unlike open back surgeries, the endoscopic, outpatient surgical procedures require only local anesthesia and deep IV sedation and do not require an overnight stay in the hospital.
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