Spondylosis Vs. Spondylolisthesis 101: Symptoms and Treatment
By Victor M. Taylor, M.D. DABA
Spondylosis is an umbrella term for deterioration of the spinal vertebrae and associated structures particularly the disc and facet joints. Spondytolisthesis is a term used when one of the vertebrae slips forward over another.
Causes of Spondylosis and Spondylolisthesis
Spondylosis is common and could be considered a normal part of the aging process. Though almost everyone over the age of 50 years old will have some degree of spondylosis, not everyone will suffer from symptoms of the condition.
There are many factors in why it could be more severe in some over others. The condition can be strongly linked to genetics; and associated with lifestyle and use. Interestingly, many people who do hard physical work may show fewer signs of spondylosis than people who had a sedentary job. Biomechanics, or the way our muscles stabilize and move our spine, plays a big role in the deterioration from spondylosis too. For some people a trauma, such as a fall or motor vehicle accident, can start the process of spondylosis. Mostly, there is no single cause.
Spondylolisthesis, on the other hand, is less common. This condition affects a relatively small percentage of the population, and refers to the slippage of one vertebra forward on another. This occurs when part of the arch of bone that protects the spinal cord either does not form properly or fractures.
Symptoms and Treatments of Spondylosis
Spondylosis can occur at any place in the back, though it is more common in the lumbar spine/lower back, and the cervical spine/neck.
Symptoms usually come on slowly and often begin with morning stiffness or decrease tolerance for standing or other activities. Finding a comfortable position or even place to sit can become a problem. The deterioration of the disc, facets and other structures can lead to increased inflammation and pain. As the condition progresses, muscles can become tight as the body tries to compensate. Eventually symptoms may involve the nerves that go to the legs or arms depending on where the problem is. This can progress to spinal stenosis, or the narrowing of the spinal canal or foramen, where the nerves enter and exit the spine, leading to weakness and difficulty walking or loss of strength in the hands and arms.
Early treatment can include over the counter anti-inflammatories, chiropractic care, physical therapy and exercise. Early intervention aimed at improving biomechanics of the core muscles and muscles of the upper legs, can help slow the advancement of spondylosis or even reverse it to some degree.
Inversion therapy can be helpful but consult your doctor before trying this. Some conditions can be made worse by traction and inversion.
When symptoms do not respond to physical therapy, inversion or chiropractic, or are interfering with your function, it is time to see an interventional anesthesiologist. Minimally invasive outpatient procedures such as epidural steroids can break up adhesions and decrease inflammation. This treatment can often eliminate the symptoms in arms or legs completely, while helping with back pain.
In patients with only spine pain, either back or neck, medial branch radio frequency ablation can decrease pain and return you to function.
For over 80% of people, in my clinical experience, these interventions are effective. Many patients go for years without pain after treatment. For those patients where the treatment is only effective for up to 6-12 months, you can repeat when necessary to help maintain a higher quality of life.
In cases where spondylolysis has progressed to the point of causing weakness or moderate to severe stenosis, spinal surgery may be necessary.
If surgery is not an option, or the pain persists even when you have had surgery, then Spinal Cord Stimulation may be the next option for you. Spinal Cord Stimulation is an advanced technology that has proven very effective in cases of persistent pain that cannot be controlled by other means.
Symptoms and Treatments of Spondylolisthesis
Symptoms of Spondylolisthesis often begin just like spondylosis. Most patients with spondylolisthesis will also have spondylosis, although the opposite is not true. When one vertebra moves forward over the other just a little, we consider this a grade I. If the vertebra slips completely off the bone it was sitting on, we consider this a grade 5.
As the slippage worsens it can lead to spinal stenosis, which can put pressure on the central spinal canal and the foramen. The narrowing can create pressure on the nerves leading to symptoms of radicular pain/pain down the leg, like sciatica, weakness and depending on where the slippage is, loss of bowel or bladder control.
Early treatment is similar to spondylosis and is directed at stabilizing the core muscles and improving biomechanics. If the pain is pronounced and the slippage is not too far progressed, epidural steroids and medial branch radio frequency ablation can help.
If the slippage is a grade II or greater, or even a grade I with intractable symptoms, or weakness, then spinal surgery is likely necessary. Of course, only a qualified spine surgeon can say for certain when surgery is needed.
Medications and Spinal Pain
Judicious use of anti-inflammatories can be very helpful. These medications can damage the kidneys and stomach so if using more than a couple of times a week it is probably time to visit a physical therapist or chiropractor and get serious about your flexibility and core. If you are not responding to this step, consult an interventional anesthesiologist, often called a pain doctor.
As a general rule, strong opioid pain medications are not indicated for spinal pain and can do more harm than good long term. However, there is no rule that fits every person and it is up to you and your doctor to determine what is the best course of action regarding medications.
Medications that can quiet the signal sent from hyperactive nerves often associated with pain can be effective and include gabapentin and Lyrica among others.
As noted NSAIDs can be helpful but could be harmful to the kidneys and stomach; and are not appropriate for all people, due their individual health factors.
For some people muscle relaxants can help too.
Generally we approach a treatment of spinal pain by using a three pronged approach:
- Rehab; and
- Minimal invasive interventions, such as epidural steroids and medial branch radiofrequency
All three can be used to help improve biomechanics. Where necessary, spinal surgery or spinal cord stimulation with a continuation of medications, and strengthening can also be the answer too.
General Treatment To Living A Happy Life
Awareness is a good place to start with either spondylosis and spondylolisthesis. When you have awareness of either condition you can start talking with your doctor and take the steps it takes to support your pain management and prevent further damage to your spine. Also, generally living a healthy and active life will improve your symptoms. Maintain a good core and ab strength, stretch regularly, and work on the flexibility in your spine and legs. Also, the less weight you carry on your lumbar spine, will help improve your symptoms of these two conditions; so it is important to stay in shape.
A healthy lifestyle is imperative to improving the biomechanics of your spine and will, therefore, create a better quality of life for those suffering from either condition.