Chiropractic Treatment For Spondylolisthesis From Trusted Bournemouth Chiropractors | Charminster Chiropractic Clinic

Spondylolisthesis is a complex spinal condition that happens when a vertebrae in the spine slips forward over the vertebrae below. This slip can lead to a lot of symptoms from mild pain to neurological problems that can affect patients’ quality of life. Understanding the whole picture of spondylolisthesis, its causes, pathophysiology, clinical presentation, diagnostic approaches, and treatment options, is important for our Bournemouth chiropractors to effectively help diagnose, manage and treat the people who are affected by spondylolisthesis.

What is spondylolisthesis

The spine is composed of bones (vertebral bodies) that are separated by discs that look like inflatable pillows (intervertebral discs), with gliding bones (facet joints) that holds a lot of weight and stabilises the spine and makes sure it moves safely. Spondylolisthesis most often affects the lower back (lumbar spine), particularly at the lowest level (L5-S1). It can be divided into several types based on its cause.

Isthmic Spondylolisthesis

Isthmic spondylolisthesis can come about from a weak spot or broken bone (fracture in the pars interarticularis), a bony bridge between the upper and lower bones (articular processes) on the back part of the vertebra. It is often seen in young athletes who are taking part in activities that repeatedly bend their back backwards into a banana shape (hyperextend). This is most commonly seen in people attending gymnastics and weightlifting. 

Degenerative Spondylolisthesis

Wear and tear can happen in the spine as well. Over time the load can start to irritate the bones in the spine. This can squeeze the inflatable pillow (disc) and deflate it so that it becomes smaller. The supporting bones in the back of the spine (facet joints) can also become irritated because of the friction and load. These painful, inflamed and puffed up bones are what we call arthritis. The tunnel (ligamentum flavum) where the nerves exit the spine can also become narrower as a result of the bones surrounding it get bigger (hypertrophy), as if the tunnel is slowly shrinking. Unfortunately, it is more common in elderly and often occurs in the second lowest part of the lower back (L4-L5). 

Traumatic Spondylolisthesis

Traumatic spondylolisthesis occurs from sudden damage as a result of injuries that can break parts of the bones of the spine and can cause the vertebrae to slip forward.

Pathological Spondylolisthesis

Pathological spondylolisthesis is connected with diseases (underlying conditions) such as tumours, infections, or metabolic bone diseases. These diseases can weaken the parts of the spine that hold the bones in place and lead to the vertebrae slipping forward. 

Common causes

There are a few causes that can make the chance higher of ending up with spondylolisthesis.

Genetic Predisposition

Genes can affect the progress of the slipped vertebrae, as some differences (anatomical) or weaknesses in the spine that patients are born with can affect the supporting bones (pars interarticularis).

Repetitive Stress and Sports Participation

Activities that involve repeatedly bending the lower back backwards, such as gymnastics, football, or weightlifting, makes the risk higher of developing “isthmic spondylolisthesis”.

Age-related Changes

Wear and tear (degeneration) in the spine affecting the disc and supporting bones, are common risks for degenerative spondylolisthesis, particularly in elderly. 

Trauma

When an incident occurs and the load on the spine becomes too great, the injury to the spine can lead to traumatic spondylolisthesis. The broken bones can cause the vertebrae to loosen and slip forward. 

Anatomical Abnormalities

Deformities in the spine that patients are born with can affect the supporting bones to slip (dysplasia) and change the structure of the vertebral body. 

Common symptoms of spondylolisthesis

Spondylolisthesis can present in many ways based on the severity of vertebral slip and how much the nerves are affected.

Low back pain

Patients often experience lower back pain and is the most common symptom of spondylolisthesis. The painful movements are often made worse when moving and doing activities that involve bending the low back backwards. Patients often find it better and easier when they rest and tuck their knees up to the chest. 

Radicular Symptoms (Sciatica)

The nerves that exit the spinal cord (nerve roots) can also become squeezed and cause pain down into the buttocks, legs or feet and cause the symptom, sciatica (radiating pain). Patients can sometimes feel little or no pain however, feel numbness, tingling, pricking or weakness instead. People would often think of these symptoms as sciatica.

Neurological Deficits

If the case is really bad and becomes worse, the spinal cord can shrink and could lead to weakness or uncontrolled bowel or bladder. This rare dysfunction, cauda equina syndrome, needs urgent medical intervention. 

Spinal Instability

If the slippage of the vertebrae happens slowly over time, it can lead to an unstable spine. If you were to see this on a film, it would show a spine that is out of line (abnormal spinal curvature e.g., hyperlordosis). The patients often notice that it can be hard to stand upright or hard to move around.  

When to seek urgent help

It is very important to seek urgent medical help if you experience the following symptoms.

• Sudden onset of bowel or bladder dysfunction: This is a medical emergency indicating compression of the cauda equina nerves.
• Progressive weakness or numbness: Especially if it affects both legs or is associated with difficulty walking.
• Severe, unrelenting pain: Even when you have used rest and pain medication. 

Risk factors for spondylolisthesis

Several factors increase the risk of developing spondylolisthesis.

Age

Wear and tear in the spine are more common with ageing, making elderly more vulnerable. 

Genetics

Sometimes genes can make it more likely to get spondylolisthesis, as it can run in families.

Gender

Some studies suggest that it happens more often in males, especially for isthmic spondylolisthesis.

Participation in certain sports

Activities such as gymnastics, weightlifting, and football, increase the risk of fracture (pars interarticularis fractures). 

Trauma

Injuries to the spine in the past, such as fractures, increase the likelihood of traumatic spondylolisthesis.

Bone diseases

People who suffer from diseases like osteoporosis will have weakened bones, making them more likely to break the bones holding the spine together and get slippage of the vertebrae.

Examination and diagnosis of spondylolisthesis

Diagnosing spondylolisthesis involves a detailed and specific evaluation that may include a detailed history and a range of tests.

Medical history

Including symptoms, previous injuries, and family history of spine disorders.

Physical examination

To assess range of motion, neurological function, and presence of muscle weakness or sensory deficits.

Imaging studies

Imaging and radiology such as x-rays are typically the initial imaging modality to confirm the diagnosis and determine the degree of slippage. CT scans provide detailed images of bony structures and can reveal pars defects or fractures. MRI scans are useful for assessing soft tissues, including nerves and discs, and can identify any nerve compression or spinal cord abnormalities.

Chiropractic treatment for spondylolisthesis

Chiropractic care is a conservative treatment option for managing spondylolisthesis, focusing on providing pain relief and improved biomechanics for many individuals with spondylolisthesis. We would like to emphasise that we are cautious and thorough before treating spondylolisthesis. Especially in cases of severe slippage or when neurological symptoms are present, chiropractors will refer and work with other healthcare providers. These could be orthopaedic surgeons and physical therapists, which may be necessary for comprehensive management. Please note: Treatment will only be provided after a thorough assessment and that treatment will be clinically indicated and deemed beneficial to the patients.

Chiropractic spinal manipulation (adjustments)

Spinal manipulatgion have the purpose of improving spinal movement, motion and function in order to help improve biomechanics thus reducing pain, and enhancing overall spinal function. 

Manual therapies

Manual therapies can also include massage, stretching exercises, and mobilisation techniques to alleviate muscle tension, improve flexibility, and restore range of motion. 

Long-term Management

Regular follow-up visits and maintenance care with our Bournemouth chiropractors can be helpful and essential to some in order to relieve pain, monitor your recovery, assess spinal stability, or even address any possible complications after the operation. 

Exercise programs

Exercise programs are very important in order to strengthening the core muscles supporting the spine, improve overall and spinal strength, posture and flexibility, stabilise the affected segment and a safe return to daily activities and work. 

Patient education

Focus will be on habits such as poor posture, good work environment, better body mechanics, lifestyle modifications to prevent reinjury and promote spinal health. Avoiding activities that make symptoms worse, such as heavy lifting or excessive bending, can help decrease pain and prevent further vertebral slippage. 

Surgery

Laminectomy and Decompression

Surgical decompression of either the nerves exiting the spinal cord (nerve roots) or the spinal cord itself may be needed in patients with severe spinal stenosis or neurological deficits caused by spondylolisthesis. 

Spinal Fusion

The most common surgical procedure for spondylolisthesis involves spinal fusion, where two or more vertebrae are permanently joined together to stabilise the spine and prevent further slippage.

Prognosis

The prognosis of spondylolisthesis depends on several factors.

Treatment approach

Early diagnosis and appropriate management can help prevent progression and improve the condition long-term. Surgical intervention, such as spinal fusion, may be necessary for patients who do not respond to chiropractic treatment, physiotherapy or develop further neurological issues. 

Severity of slippage

Mild to moderate cases often respond well to chiropractic care and conservative care. Severe cases or those associated with serious neurological deficits may require surgical intervention.

Age and overall health

Younger patients with fewer degenerative changes tend to have better outcomes with chiropractic treatment and conservative care.

The Bournemouth chiropractors at Charminster Chiropractic Clinic are pleased to help you with spondylolisthesis symptom management and chiropractic treatment for you. Book your chiropractic appointment here today!

References

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National Center for Biotechnology Information. (2022). Spondylolysis and Spondylolisthesis: Pathology, Presentation, and Treatment. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK560679/

Singh, P. K., & Vasishtha, R. K. (2018). Spondylolisthesis: A Review and an Evolutionary Concept. Global Spine Journal, 8(8), 842–850. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5990218/

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