Lumbar spondylolisthesis is the subluxation (slippage) between the lumbar vertebrae (spinal bones). In this spinal condition, a vertebrae slips forward on the verterbra below it. Normally this is prevented from happening by the disc, facet joints, ligaments and surrounding muscles. The facet joint is one of the main structures that holds the vertebrae in place so it doesn’t slip forward on the vertebrae below it. The pars is the intersection between the transverse process, the superior and inferior facets and is a point under stress that can lead to small breaks resulting in a slip.

This process can lead to spinal canal stenosis (narrowing of the lumbar spinal canal) which puts pressure on the spinal cord or sciatic nerve roots (the spinal nerve that travels down to the leg.) This can lead to both localized lower back pain/spasm and sciatica.

Causes of lumbar spondylolisthesis include:

  • Degenerative changes (‘wear and tear’) in the facet joints or pars
  • Fracture caused by traumatic injury or lifting heavy loads can result in a fracture through the pars
  • Congenital defects of the pars and facet joints

Signs & symptoms What tests are needed? How is it diagnosed? When surgery will be considered Surgical treatment

Signs & symptoms

In many cases of lumbar spondylolisthesis, patients experience no symptoms at all. In most cases, symptoms usually resolve spontaneously over about six weeks. Signs and symptoms that patients experience include:

  • Shooting pain that travels down the leg (radicular pain/sciatica). This is usually from compression of the spinal nerve that travels down to the leg.
  • Low back pain that can be quite generic in nature or focused at a particular spot. LBP can be accompanied with radicular pain/sciatica.
  • Cramps or spasms.
  • Sensation changes such as numbness or pins and needles (paraesthesia) in the bottom of the leg or foot.
  • Weakness or motor deficit. This does not always occur but if it does it means that a spinal nerve is very compressed.
  • Difficulty walking significant distances.

What tests are needed?

Magnetic Resonance Imaging (MRI) and/or Computed Tomography (CT) will be performed when planning surgery to help confirm diagnosis, understand the anatomy, look for bony pars defect and to provide information on the extent of spinal canal and nerve narrowing. X-rays are performed to look for instability of the spine (show the slip and if a fracture is present).

How is it diagnosed?

Diagnosis is made from the findings of the clinical examination, your symptoms and relevant tests.

When surgery will be considered

  • Surgery will be considered as the last resort when you have ongoing symptoms despite non-surgical treatment.
  • Significant radicular pain (or sciatica)- shooting pain that travels down the leg and/or buttock pain.
  • Weakness, motor deficit in the leg/s or difficulty walking.
  • Sensation changes such as numbness or pins and needles (paraesthesia) in the leg/s.
  • If on x-ray, the slip is worsening.

Surgical treatment

The aims of surgery for lumbar spondylolisthesis are to bring stability to the spine, relieve compression to spinal nerves and spinal canal to improve your symptoms. Mr Gomes performs a number of surgeries for this condition.

  • Lumbar Fusion – permanently connects two or more vertebrae in your spine. It is usually needed if there is severe disc degeneration associated with loss of height and/or subluxation (slippage between the vertebrae.) The kind of surgery needed to achieve fusion depends on patient factors such as anatomy, spinal level and symptoms. The technique used will be discussed in detail by Mr Gomes.

    The options for surgery which may be able to be done as a keyhole approach include:
         PLIF – Posterolateral Lumbar Interbody Fusion
         TLIF – Transforaminal Lumbar Interbody Fusion
         ALIF – Anterior Lumbar Interbody Fusion

For all appointments and enquiries, please phone   03 8318 4929

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