Spondylolisthesis (Spinal Instability)
This rare condition (spondylolisthesis - slipped vertebra, spinal instability) is characterised by dynamic back pain and pain spreading down from the lower back, through the buttock down the back of the leg into the calf or foot. The leg pain is usually severe in the early stages and feels like an electric shock in the leg. It may be made worse by coughing or sneezing. It is often associated with altered sensation or ‘pins and needles’ in the leg or foot. Occasionally there may be weakness of the affected leg or foot.
**If you develop severe pain in both legs, difficulty in passing urine, incontinence, or loss of sensation around your genitals, then you should attend your nearest A&E department as a matter of emergency**
Treatments:
- Gentle exercise and simple analgesia (ibuprofen)
- Specialist pain management (medication, exercise, TENS, acupuncture, psychotherapy, spinal injections, facet joint injections, rhizolysis / medial branch blocks)
- Physiotherapy
- Lumbar fusion PLIF
Outcomes:
- 80% of patients improve following surgery, with the majority seeing complete resolution of their sciatica. Back pain may become more bearable after surgery, but surgery will not cure back pain.
- A few patients will have a technically successful operation but continue to have symptoms due to persisting nerve injury
- A few patients will go on to develop scar tissue or a recurrent disc prolapse, causing recurrent symptoms which can be difficult to manage
The most common cause of the spondylolisthesis is advanced spinal arthritis causing joint destruction and instability. In younger patients it can be caused by a stress fracture – common in keen athletes and gymnasts. This condition may require surgery – see treatments - lumbar fusion PLIF.
In addition to an outpatient assessment and examination you may require an MRI scan if your symptoms persist. (Most patients with a slipped disc will improve without surgical treatment within 6 weeks). An MRI scan is a powerful magnet that creates a picture of your spine without any radiation exposure. The scanner is a long tunnel. The modern scanners now available are less narrow and do not cause claustrophobia for most patients. It is still fairly noisy during the scan however as the magnet clicks on and off. It may also be necessary to undertake a CT scan and dynamic x-rays to get a clearer picture of the bones in the spine and any abnormal movements.
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