Degenerative Spondylolisthesis

Degenerative changes in the spine can lead to slippage of one vertebra on the next, leading to the development of back and leg pain, numbness in the legs and reduced mobility.

Overview

Crucial: the right treatment at the right time

Schoen Clinic specialise in the treatment of acute and chronic disc herniation (disc prolapse). Whether an exact diagnosis, conservative treatment or precise disc surgery – you will benefit from the experience of our spine specialists.

Causes & Symptoms

Degenerative spondylolisthesis is the forward slippage of one lumbar vertebra on the vertebra below it. The slippage occurs because of wear and tear in the facet joints at the back of the spine. The degree of spondylolisthesis may vary from mild to severe. Symptoms may include lower back pain and pain in the thighs and buttocks, stiffness, muscle tightness and discomfort in the area of the slippage.

The forward slippage can create narrowing of the spinal canal or spinal stenosis. In lumbar spinal stenosis, the spinal nerve roots and/or cauda equina (spinal nerves) become compressed by the narrowing of the spinal canal. This is as a result of the enlargement of the joints by the spine bony overgrowths (osteophytes) which grow into the spinal canal. This is made worse by buckling of the ligamentum flavum (the thick ligament that connects the laminae of adjacent vertebrae) and/or bulging of the discs. 

When nerves are compressed they can produce symptoms of pain, numbness or tingling in the area of the leg that the particular spinal nerve supplies. In rare cases they can produce severe pain and even weakness in the legs, such that the ‘legs don’t work’. In most cases, the symptoms are experienced when standing or walking and are relieved by sitting or bending forward. In rare cases the nerves which control your bladder, bowel and sexual function can be compressed. This is known as cauda equina syndrome (CES) and often requires urgent surgical intervention. Fortunately, immediate spinal surgery is only necessary in a few cases.

Spinal canal stenosis in the lumbar spine:

  • Your legs feel heavy, painful and numb
  • You often have to stop when walking
  • Bending over forward relieves pain, so you tend to bend over when walking or support yourself on a shopping trolley.

Diagnostics

Diagnosing degenerative spondylolisthesis requires experience. There are many symptoms which are linked to the spondylolisthesis and the spinal canal stenosis meaning the condition can often be overlooked. With thorough diagnostic tests, we can find the cause of your problems and initiate the appropriate treatment.

Every diagnosis at Schoen Clinic begins with an extensive consultation and a thorough physical examination. After assessment we can confirm the diagnosis with imaging methods and precisely determine the level and extent of the spondylolisthesis and associated stenosis.

Degenerative spondylolisthesis can be seen on an x-ray of the spine. Other tests such as magnetic resonance imaging (MRI) are required to look at the spine in more detail and to assess the degree of stenosis. In this procedure, we can optimally visualise the spinal canal and the neural structures such as the spinal cord and nerve roots that pass through it. On occasions we may have to perform other tests such as a CT scan or neurophysiology testing.

Treatment Options

Once we have diagnosed that you have a degenerative spondylolisthesis with associated spinal canal stenosis, we use various treatment methods, depending on the severity and the symptoms. Our consultants and therapists will develop an individual treatment plan for you. 

If the slippage and the narrowing of the vertebral canal is not yet very advanced, conservative measures such as physiotherapy can often help. The goal of our treatment programme is to relieve your pain significantly and improve your quality of life.

In some cases, spinal injections, performed as a day case procedure, may be appropriate and can relieve some of the acute pain. 

In many cases most conservative treatments (e.g. manipulation, physiotherapy, medication or injections) are unlikely to be of much long-term benefit, and the symptoms rarely improve permanently without surgery to take the pressure off the nerves (decompression). A stabilisation procedure of the spine may also be required.

The objective of surgery is to remove the material that causes the compression/stenosis and to give the nerve roots and/or cauda equina more room. Your surgeon will decide whether there is a need to stabilise the spine by using an internal implant system. Sometimes extensive decompression surgery can further weaken the spine’s stability, so the exact extent of surgery can only be decided during the procedure.

Aftercare

It is very normal to experience some level of discomfort/pain after the surgery. Our experienced nursing and medical staff will help you to control this with appropriate medication. The symptoms in your legs may fluctuate due to increased swelling around the nerves. This can take a few weeks to settle. It is important not to suddenly stop taking certain pain relief medication. Our ward physiotherapist will visit you after the operation to teach you exercises and help you out of bed. They will show you the correct way to move safely. Once you are confident and independently mobile, you will be encouraged to keep as mobile as possible.

Treatments are available at the following locations

Schoen Clinic London

Our Address
Schoen Clinic
Orthopaedic and Spinal Hospital London
66 Wigmore Street
London W1U 2SB
General Telephone Enquiries
+44 (0)203 929 0801
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