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Lumbar Spondylolisthesis Specialist
Dr Poh Seng Yew
MBBS
MRCSEd
MMED (Ortho)
FRCSEd
What is Lumbar Spondylolisthesis?
Lumbar spondylolisthesis is a spinal condition characterised by the displacement of one vertebra in the lower back, known as the lumbar region, over the vertebra directly beneath it. It can manifest across different age groups, though it is seen predominantly in adults.
This condition may limit mobility, making standing, walking, and engaging in physical activities challenging. This could lead to difficulties in performing routine tasks such as bending and lifting.
Causes of Lumbar Spondylolisthesis
Lumbar spondylolisthesis can result from a variety of factors, including:
- Degenerative Spondylolisthesis
Age-related degeneration of the intervertebral discs and facet joints is a common cause, especially in older adults. As the discs deteriorate, they lose the ability to support the spine properly, which can lead to spondylolisthesis. - Congenital Spondylolisthesis
In this form, individuals are born with structural abnormalities in the spine, which predispose them to this condition. Examples include incomplete formation of vertebrae or atypical facet joints. - Traumatic Injury
Spondylolisthesis can also develop following a traumatic event such as a car accident, fall, or sports injury, which causes fractures or damage to the vertebrae. - Isthmic Spondylolisthesis
This is often linked to a small stress fracture in the pars interarticularis of the vertebra. Over time, it can lead to the forward displacement of the affected vertebra. - Pathological Spondylolisthesis
This type occurs due to medical conditions like tumours or infections that weaken the vertebrae, causing them to slip out of alignment. - Post-surgical Spondylolisthesis
In rare cases, post-surgical spondylolisthesis can occur as a complication of spinal surgery, especially if the surgery alters the spine’s natural stability.
Symptoms and Signs
The symptoms of lumbar spondylolisthesis typically manifest in the lower back and lower extremities.
- Lower Back Pain: The primary symptom is lower back pain, which can range from a mild ache to sharp, severe discomfort. This pain often intensifies with certain movements like bending or twisting and may radiate into the buttocks or legs.
- Numbness, Tingling and Weakness in the Leg: These sensations or weakness may occur in the legs, particularly when the nerves are compressed or irritated by the displaced vertebra.
- Changes in Gait or Posture: This can be due to muscle imbalances or balance difficulties.
- Difficulty in Everyday Activities: This includes challenges in walking, standing, or performing physical tasks.
Diagnosis
Diagnosis of lumbar spondylolisthesis typically involves the following steps:
- Medical History and Physical Examination: The diagnostic process begins with a detailed review of the patient’s medical history and a physical examination. The spine specialist seeks to understand the patient’s symptoms, their onset, and any relevant past injuries. The physical examination includes assessing posture, mobility, and nerve function.
- Imaging Studies: These can help confirm the diagnosis. X-rays provide a clear visualisation of the spine’s alignment, revealing the presence and extent of vertebral slippage. For more detailed assessments, particularly of soft tissues, nerve compression, and other abnormalities, MRIs or CT scans can be utilised.
Non-Surgical Treatment Options
Management of lumbar spondylolisthesis typically includes a variety of non-surgical methods, tailored to reduce pain, improve mobility, and enhance the quality of life.
Rest |
Initially, the spine specialist may suggest a period of rest, to help alleviate pain and prevent further deterioration of the condition. |
Bracing |
For certain individuals, especially those not suitable for surgery, a back brace may be recommended to support the spine and limit movement. |
Physical Therapy |
Exercise programs can be tailored to strengthen the core and lower back muscles, increase flexibility, and improve posture. This can thus reduce pain and stabilise the spine. |
Medications |
Over-the-counter or prescription medications such as non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants are often prescribed to manage pain and inflammation. |
Epidural Steroid Injections |
In cases where conservative treatments are less effective, injections of corticosteroids into the affected area can provide temporary relief from pain and inflammation. |
Surgical Treatment Options
In more severe cases of lumbar spondylolisthesis or when non-surgical treatments fail to provide sufficient relief, surgical intervention may be considered.
Spinal Fusion
This is a common surgical procedure for stabilising the affected vertebrae. The process involves fusing two or more vertebrae into a single, solid structure, often using screws and rods.
Laminectomy
This procedure is primarily performed to relieve nerve compression. It involves the removal of bone spurs and thickened ligaments that cause compression. In some cases, the spine can be decompressed using other surgical methods.
Minimally Invasive Surgery
Techniques like microdiscectomy or minimally invasive fusion aim to minimise tissue damage, reduce scarring, and accelerate recovery compared to traditional open surgery.
Prevention Strategies
While not all cases of lumbar spondylolisthesis can be prevented, several strategies can help reduce the risk or slow the progression of the condition.
- Regular Exercise - Engaging in activities that strengthen the core and lower back muscles can enhance spinal stability and flexibility, reducing the risk of injuries that could lead to spondylolisthesis.
- Maintaining a Healthy Weight - Excess body weight puts additional stress on the spine, particularly the lumbar region. Keeping a healthy weight can alleviate this stress.
- Proper Posture and Ergonomics - Adopting correct posture and ergonomic practices, especially while sitting and lifting, can prevent undue strain on the lower back.
- Avoiding High-Impact Activities - Activities that put excessive stress on the lower back, such as heavy lifting or high-impact sports, should be approached with caution or avoided if possible.
- Maintaining Good Bone Health - Ensure adequate intake of calcium and vitamin D to maintain spine integrity. This is particularly necessary for postmenopausal women who may be at higher risk due to bone density changes.
Dr Poh Seng Yew
MBBS
MRCSEd
MMED (Ortho)
FRCSEd
With over 18 years of experience, Dr Poh Seng Yew is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.
- Former Director of Sports Service, Department of Orthopaedic Surgery, Singapore General Hospital
- Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany
- Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
- Master of Medicine (Orthopaedic Surgery), National University of Singapore
- Member, Royal College of Surgeons of Edinburgh (MRCSEd)
- Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore
Insurance
Shield Plans
Corporate Partners
Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
Weekdays: 9.00am – 5.00pm
Saturdays: 9.00am – 1.00pm
Sundays and Public Holidays: Closed
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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
Frequently Asked Questions (FAQ)
Can I Exercise with Lumbar Spondylolisthesis?
Exercise is often beneficial for individuals with lumbar spondylolisthesis. Focus on low-impact activities and exercises that strengthen the core and lower back muscles to help enhance spinal stability. It is recommended to approach exercises with moderation to avoid potential exacerbation of the condition. Consulting a spine specialist can help you recognise any risky activities and provide you with a tailored exercise plan that aligns with your specific condition and needs.
How Long Does Lumbar Spondylolisthesis Take to Heal?
The healing process for lumbar spondylolisthesis varies depending on the severity of the condition and the chosen treatment method. While conservative treatments can alleviate symptoms, they do not ‘heal’ the slippage of the vertebrae. For surgical treatments, recovery times can range from a few months to longer, depending on the type of surgery and individual healing rates.
What Happens if Lumbar Spondylolisthesis Goes Untreated?
If left untreated, lumbar spondylolisthesis can lead to persistent pain and potentially progressive nerve damage, resulting in symptoms like numbness or weakness in the lower extremities. In some cases, it can lead to chronic pain and mobility issues, impacting daily activities and quality of life. Seek a consultation with a spine specialist for a comprehensive evaluation and to discuss the most effective treatment options for your specific situation.