Spondylolisthesis

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Spondylolisthesis is the displacement of one spinal vertebra (bone) compared to another. It usually means a fracture occurred at the region known as the “pars interarticularis”. This can result in a forward slippage of the bone called anterolisthesis. These fractures are usually the result of repetitive stress from excessive hyperextension or “backbends” and commonly involve the fifth lumbar vertebra. Spondylolisthesis or “Spondys” are common among gymnasts, football lineman and individuals who perform weight training with bad form. As many as 7% of adolescence athletes have spondylolisthesis. (Kim et al 2018)

X-Rays

Spondys are easily seen on a lateral or side view X-Ray. They Do Not require immediate advanced imaging like MRI. In fact, research demonstrates that early MRIs often lead to poor health outcomes. If an MRI is ordered ask for STIR sequence MRI which may reveal inflammation indicating whether your condition is acute or active. IMPORTANT: Not all Spondylolisthesis are active sources of back or leg pain. Indeed, many patients don’t learn of their Spondylolisthesis diagnosis until many years later, often in their 50s. So if you have lower back or leg pain a physical exam MUST accompany any X-ray or MRI based diagnosis.

Lateral X-ray demonstrating an L5 Spondylolisthesis in a 13 year old male football player.

Treatment Options

If you’ve been diagnosed with Spondylolisthesis you should avoid any movements which require repeated back flexion or extension. You should stop the following exercises immediately: sit-ups, leg press, leg extension, Russian twists, back squats, pogos and anything that sacrifices a neutral spine. If you’re a concerned parent or coach of a youth athlete you must have them cease all aggravating activities IMMEDIATELY.

Medical

Medical treatment includes activity restriction to the level required for relief. Research published by Gagnet et al in 2018 found that Low-intensity pulsed ultrasound (LIPUS) in addition to conservative treatment appears to be very promising for achieving a higher rate of bony union. They concluded that bracing and decreased activity to be the most effective with patients who have early diagnosis and treatment. However, Crawford's 2017 systematic review concludes that “the role of medical/interventional bracing is not well established”. Since the research is conflicting, the recommendations you’ll receive from doctors may differ as well. Thankfully surgery is rarely necessary and conservative chiropractic care is safe and effective. 

Conservative Treatment

Gonstead Trained chiropractors have extensive postgraduate training in the management of disc and fracture cases. Spondylolisthesis is not a contraindication to prudent adjustments. The adjustment is designed to reduce pain and restore motion at the spinal level below the spondylolisthesis. Since spondy’s frequently involve the L5 vertebrae the L5-S1 joint articulation becomes a subluxation. The S2 segment of the sacrum (an area below the spondy) is the contact point for a specific adjustment. Improvement in the forward slippage rarely occurs. However, pain relief and improved mobility is achieved. As symptoms improve, adjustment frequency is reduced. Reducing the sacral base angle is helpful in decreasing the shear force on the joints. This can be accomplished with posterior pelvic tilt exercises. I recommend 200-400 pelvic tilts per day. 

Pending Spondy

Some doctors and therapists still employ an old osteopathic leg yanking maneuver. You must stop this immediately. This maneuver results in a retrolisthesis. A retrolisthesis is when the bone shifts backwards. This is problematic because backwards displacements narrow our nerve openings (called IVFs) and jam our facet joints leading to painful inflammation. A retrolisthesis puts student athletes at risk. This active inflammation and facet joint jamming can develop into a spondylolisthesis, a condition author Dr Terry Yochum calls “a pending spondy”. Thankfully, retrolisthesis has been shown to be reducible in as little as 12 Gonstead adjustments. 

If you’re looking for a diligent chiropractor in Edmond OK then please give us a call. If you have questions, consider scheduling a complimentary consultation. You’ll have an opportunity to share your concerns and interview our gonstead trained chiropractors. You can decide if moving forward with an exam and x-ray makes sense.  We’ll verify your insurance benefits and explain your coverage. You can also see our self-pay prices here.