Spondylolisthesis

Most people with spondylolisthesis have a narrowed spinal canal (spinal stenosis). This doesn’t always cause symptoms.

If there are symptoms, the typical one is pain in the lower back, which spreads to the bottom or thighs and sometimes to the lower legs or feet. It can occur on one or both sides of the body. Other possible symptoms are tingling or numbness in the legs or feet – a bit like when they feel “asleep.”

Some people have quite minor pain; for some it’s more severe. It tends to get worse if you move or put pressure on your back, by standing for a long time for instance. When you rest, it gets better. It can also differ from day to day.

The symptoms can be very distressing, especially if they restrict your mobility, make you unsteady on your feet or cause problems with things you usually do at work, home or in your leisure time.

Certain symptoms require immediate medical attention, including not being able to move your limbs properly, feeling shaky on your legs, numbness around the perineum (the area between the anus and genitals) or your bladder/bowel suddenly not working properly. These symptoms can be a sign of nerve damage, requiring surgery right away. These kinds of emergency are very rare, but they need to be dealt with quickly.

Spondylolisthesis usually happens due to aging (degeneration) of the spinal discs and vertebral joints. Over time, the discs lose fluid and become brittle and cracked.

This can cause vertebrae to slip out of place and protrude into the spinal canal. Because of this, people with spondylolisthesis usually have spinal stenosis – a narrowed spinal canal. The spinal cord, nerves and vessels run through this canal. The nerves in the spinal cord send signals from the brain to every part of the body. They also report sensations like touch, cold, heat and pain back to the brain. If your spinal canal has become narrowed and bones, ligaments or the spinal disc are putting pressure on your nerves, it can result in noticeable symptoms. But it’s often difficult to say what abnormalities in the spine are actually causing the problems.

If the affected vertebrae have both slid out of place and are moving back and forth, it’s called unstable spondylolisthesis. But there aren’t any conclusive findings about how this affects the symptoms. Nor are there any standardized criteria for diagnosing unstable spondylolisthesis.

Spondylolisthesis typically begins after the age of 60. An estimated 2 to 4 out of 100 people have the condition and symptoms by this age. In the majority of spondylolisthesis cases, the vertebra is only slightly out of place.

There is hardly any research on how symptoms usually develop. A large-scale study carried out in Germany suggests that they get a little better over time.

To diagnose spondylolisthesis and spinal stenosis, your doctor will first ask:

• what type of pain you have,
• whether it spreads to your legs,
• when you feel it and when it goes away (when you sit down, for example, or bend your upper body forward or prop it up), and
• whether you have any tingling, numbness or balance problems as well.

They will also ask what other conditions you have, whether you’ve had any accidents or surgical procedures recently and what medication you take.

Then they’ll do some tests and look at how you walk. One test they might use is to ask you to stand with your feet close together, stretch your arms out in front of you and close your eyes for ten seconds. If you lose your balance, it might be a sign of a narrowed spinal canal. Other tests look for things like sensory disorders in your skin caused by nerve problems – like numb areas of skin.

Imaging techniques like x-rays, computed tomography (CT) or magnetic resonance imaging (MRI) can be used to see slipped vertebrae. However, even if the images show slippage, it doesn’t necessarily mean that’s what’s causing the pain. So imaging techniques aren’t actually always helpful – nor necessary for treatment. That’s because the healthcare professional will look at your specific problems and symptoms – not the results of x-rays or scans – if you’re prescribed physical therapy and medication.

Imaging techniques are necessary if there are signs of an emergency situation or a different problem that’s causing the symptoms, like a vertebral fracture. They are also needed before a procedure so the hospital can prepare.

If you have spondylolisthesis, it’s a good idea to stay as active as possible. But resting can help relieve your symptoms too. The aim is to find a good balance. You can do this, for instance, by dividing tasks up into smaller chunks or swapping between easier and more difficult activities. A physical therapist can also show you how to change your posture to relieve pressure and help you get through your day.

People with spondylolisthesis are usually given conservative (non-surgical) treatment. There are various different types:

• Painkillers: They can relieve pain and make it easier to stay active. Anti-inflammatory painkillers, like diclofenac or ibuprofen, are the main ones healthcare professionals recommend. It is best to only take them when you need them and to take the lowest effective dose.
• Manual and physical therapy: Research shows that targeted manual therapy can provide some relief, at least for a few weeks. There are special techniques for treating a narrowed spinal canal. They should be combined with exercises to maintain your general strength, stability and mobility.
• Rehabilitation and functional training: The doctor might prescribe rehabilitation training to increase your stamina and strength or functional training (simple exercises or exercises in water). These classes are done in a group, with a physical therapist showing you what to do.
• Multimodal pain management: This can be useful if you’ve had symptoms a long time. It’s a combination of several types of treatment, like exercise, relaxation and medical, physical or psychological therapy. As well as relieving the pain, the aim is to help you cope with the symptoms in your day-to-day life.
• Surgery: This is a possible option if you have spinal stenosis and spondylolisthesis and the condition has been causing severe symptoms for several months despite conservative treatment. However, the chances of success are limited. You’re entitled to a second medical opinion from a specialist before having this type of surgery. It’s a good idea to weigh up the pros and cons carefully because there are risks involved. The decision aids on spine procedures can help you.

In very rare cases, people have a medical emergency that requires surgery straight away. The symptoms of this type of emergency are not being able to move your limbs properly, feeling shaky on your legs, numbness around the perineum (the area between the anus and genitals) or suddenly problems peeing or pooing. They’re signs of “cauda equina syndrome,” which happens there is too much pressure on the nerve bundle at the end of the spinal cord. If it’s not treated quickly, there may be permanent damage to the nerves.

There is no cure for spondylolisthesis or spinal stenosis. The back and leg pain are usually there all the time though some days are better than others. So it makes sense to come to terms with the condition as far as possible – and to be wary of any unrealistic promises of cures. There are lots of ineffective treatments available, especially for people with chronic pain and nerve conditions. They tend to be expensive or complicated and there’s no proof that they work. They can be dangerous sometimes too.

But there is a lot that you can do on your own. Many people find it’s helpful to find out about the illness and activities that make the symptoms worse or better. Then they can make appropriate changes to their day-to-day routines. They might decide to make sure they have enough breaks or be more spontaneous in their plans so they do things depending on how they feel.

If the pain is severe and constant, behavioral therapy can help you cope too. Alternatively, the Digital Health Applications (DiGAs) available in Germany can be useful. These are web-based treatments, based on behavioral therapy methods, which doctors can prescribe for people with chronic pain.

When people are ill or need medical advice, they usually go to see their family doctor first. Information about health care in Germany can help you to navigate the German healthcare system and find a suitable doctor. You can use this list of questions to prepare for your appointment.