Spondylosis / Spondylolisthesis

Definition

Spondylosis is a term that refers to spinal degeneration in one of these regions:

  • Neck – cervical spondylosis 
  • Lower back – lumbar spondylosis 
  • Middle back – thoracic spondylosis 

The term spondylosis is most often used to refer to osteoarthritis of the spine, but may also describe any manner of spinal degeneration.

In about 5% of the adult population, there is a crack in one of the vertebrae which may develop as a stress fracture. Because of the constant forces the low back experiences, this fracture does not usually heal as normal bone. Fractures of this type, called a spondylolysis, are just cracks in part of the vertebra and may not cause any problems whatsoever. But sometimes a cracked vertebra slips forward over the one below it, causing isthmic spondylolisthesis.

Causes

The bone is weakest between pedicle and lamina, in a region known as the pars interarticularis - often simply referred to as pars. A stress fracture can occur in this region from repeated strain on the bone. At first the body can heal the damage. But if repeated stress occurs faster than the body can respond, the bone will eventually fracture. Spondylolysis often first appears in childhood. Football linemen and gymnasts tend to be the most affected.

Symptoms

Pinched or irritated nerves can cause symptoms resembling those of nerve compression. This occurs in spondylolysis when a lump of tissue forms around the crack in the bone as the body tries to heal a stress fracture. This lump applies pressure to the spinal nerves where they exit the spinal canal.  A pinched nerve can also result in spondylolisthesis when the vertebra slides forward, squeezing the nerve. The forward slip of the vertebra also reduces the size of the spinal canal, leaving less room for nerve roots.

Diagnosis

X-rays do an excellent job of revealing a pars defect or forward slip of a vertebra. A defect seen via X-ray does not necessarily confirm that your back symptoms result from that particular defect. X-rays will assist your doctor in measuring any slippage from spondylolisthesis.

Other conditions may be the actual cause of your symptoms. Your doctor will look carefully to determine all possible causes of your symptoms, and this may require other tests such as:

  • MRI - to view nerves and spinal cord
  • CT scan - for a clearer image of vertebral bones
  • Special nerve tests - in order to determine if nerves are being irritated or pinched

Nonsurgical Treatments

Your doctor may prescribe rest, and avoidance of sport activities, in order to help calm symptoms from mechanical back pain. Special braces, casts, or corsets may help heal a stress fracture and to ease pain.

Surgical Treatments

Nerve pressure may require surgical decompression, known as decompressive laminectomy of the lumbar spine. In order to free up, or "decompress" the nerves, the surgeon must remove a section of bone from the back of the spine (lamina). The surgeon may also need to remove a portion of the facet joints. The lamina and facet joints normally provide stability in the spine. Removing either or both can loosen or destabilize the spine. When this occurs, surgical treatment will likely include fusion.

Recovery

Here's what you can expect at home after your laminectomy:

  • Some significant pain is likely to occur, requiring strong medicine such as narcotics or opiates. Don't drive while taking opiate pain medicines. Most people are able to cease taking opiates or narcotics and return to driving in between one and two weeks. Your surgeon will tell you when it's safe to resume driving.
  • Limitation of activities that include bending, stooping, or lifting, for a period of several weeks following laminectomy.
  • Keep the incision site clean and dry. Your doctor can provide instructions for showering and bathing.
  • After about two weeks your doctor will remove stitches or staples. 
  • Avoid prolonged sitting, as usually happens on long plane flights or car rides. This can lead to blood clots in the legs. If you must travel during this time, stand and walk at least once per hour.

Recovery time depends on the extent of your surgery and other personal factors. Here are some general time periods to keep in mind:

  • Following minor (decompressive) laminectomy, light activity (desk work and light housekeeping) can usually resume within a few days to a few weeks.
  • If laminectomy is accompanied by spinal fusion, the recovery time is longer. Resumption of light activity may not take place until between two and four months.
  • A return to full activities involving lifting and bending may not be possible for between two and three months.
  • Begin light walking for exercise and for physical therapy exercises as soon as your doctor says it's OK to do so, as this will speed your recovery.