Lumbar Degenerative Spondylolisthesis
Lumbar Degenerative Spondylolisthesis is a condition that Dr. Huffman has treated hundreds of times over the past 15 years. It can be easily diagnosed by X-Rays and when treated appropriately most patients do very well and can go back to living a normal and healthy life. Learn about this condition, common treatments, and discover how we treat spondylolisthesis at Huffman Clinic.
What is Lumbar Degenerative Spondylolisthesis
Spondylolisthesis refers to a condition in which one of the bones in the spine, a vertebra, has shifted, or slipped, relative to another vertebra. When translated from Latin spondylolisthesis literally means slipped (listhesis) spine (spondylo). In the low back, or lumbar spine, the number one cause of Spondylolisthesis is degeneration or wear and tear changes in the facet joints and disc that connect two vertebrae together.
The symptoms of spondylolisthesis tend to develop gradually often over a period of years, though sometimes there will be a rapid onset of pain
Symptoms of Spondylolisthesis
Lumbar degenerative spondylolisthesis is painful for two main reasons. First, the wear and tear changes in the facet joints and the disc cause pain. This is usually localized to the low back directly in the area of the slippage between the two bones. It may be associated with muscle spasm as the muscles around the slipped bones are placed under extra strain trying to stabilize the slippage.
The second reason that spondylolisthesis is painful is that it can pinch nerves. The bones of the spine are made up of a large supporting part called the body with a ring of bone sticking off the back. When the bones of the spine are stacked, the rings create a tube called the spinal canal which contains the nerves. Because it is made of many separate bones, the spine can bend and twist but normally the bones will still stack evenly through these motions. When two bones shift it has a scissoring effect on the spinal canal causing it to become narrowed or pinched. This is a type of spinal “stenosis.” Stenosis means a narrowing in a tube. When the spine is stenotic it causes pinching of the nerves. To help visualize this, imagine two rings stacked on top of each other with a wire running through both rings. Now picture shifting the rings so they are not evenly stacked and think about how it would pinch the wire. This is how many wire cutters and scissors work. When nerves are pinched, they hurt! Typically, this pain will go into the buttocks and down the legs. Sometimes it will be classic “sciatica” nerve pain and other patients will complain of more cramping and aching.
Pain is the most common symptom that people with lumbar degenerative spondylolisthesis have but there are other symptoms. The second most common one is a feeling of aching and fatigue that can start in the low back but also affect the buttocks and legs. This pain is usually worse with standing and walking and is often relieved by sitting down or bending forward. Many people will note that pain is much better when they lean on a shopping cart and this is how they will get through a shopping trip even though they can not stand or walk for very long. This symptom is called “neurogenic claudication.” It is very similar to the discomfort that patients will experience if they have very poor blood flow to the legs. It is caused by pinching the nerves in the low back. The reason leaning forward relieves the pain is that it flexes the spine which pulls the rings of bone apart and decreases the pinching effect on the nerves.
Other common symptoms of lumbar degenerative spondylolisthesis include numbness, weakness, loss of balance or even a drop foot and unusual sensations in the legs which we call paresthesias or dysesthesias. Some people will insist that these are not pain sensations. These symptoms are caused by the nerves not working properly when they are pinched so the wrong signals get sent to the brain or the signals from the brain do not get through the nerves to control the muscles in the legs. Rarely the interruption in the signals from the brain can affect the control over bowel and bladder function which might lead to incontinence.
Treatments for Spondylolisthesis
Treatment of lumbar degenerative spondylolisthesis is divided into two categories: conservative and surgical. Conservative care generally focuses on exercising the muscles of the trunk including the stomach and back muscles with the goal of providing stability to the spine. This will hopefully help control pain and prevent or slow progression of the disease. Other conservative treatment options for spondylolisthesis include medical management and injections to provide temporary relief of the pain. It is important to note that of the conservative treatment options only exercise and therapy can change the muscles around the spine. Other treatments that focus on controlling the pain do not affect the underlying problem.
When conservative treatment for spondylolisthesis fails and symptoms are too severe to tolerate, then surgical treatment is recommended. The standard for years has been open decompression and spinal fusion. Decompression is the technique of removing disc and bone along with restoring more normal alignment to take the pressure off the nerves. Fusion is the process of making the bones heal together once the decompression has been completed to prevent the return or progression of the slip. This technique has predictable outcomes and is generally successful however using traditional techniques, it is a major surgery, often requiring several days in the hospital and several months to get close to full recovery. For this reason, some surgeons have recommended decompression alone for spondylolisthesis. The problem with this less complete technique is that it often results in making the instability worse and can lead to an even bigger problem.
How Huffman Clinic Treats Spondylolisthesis
Over the past 15 years of doing spine surgery and hundreds of cases treating lumbar degenerative spondylolisthesis, Dr. Huffman has refined a technique of minimally invasive surgery that accomplishes the same things as the open major surgery through small incisions. The results are surgery with lower complications, minimal blood loss, less anesthesia, less pain medication after surgery, one night in the hospital and for some patients outpatient, same day surgery. This is done using specially designed instrumentation that Dr. Huffman himself helped design, with a combination of image guidance and micro surgical techniques.
Dr. Huffman’s extensive experience in this technique for spondylolisthesis has led to his invitation to teach surgeons at courses in Asia, Europe, Australia and across the United States. He has also assisted medical device companies in developing their next generation of minimally invasive spinal instrumentation that will lead to better treatment and care for patients.
"My husband, Mom and I have been patients of Dr. Huffman’s for quite a number of years. The BEST spine surgeon in the county! He has operated on me twice in the past year with amazing results. Would highly recommend this gifted man."
- Vivian B., Facebook Review
"I have been a patient of Dr Huffman's for many years, with some major back issues. The care I received (and still receive) is exemplary. Staff members Sarah and Dawn are amazing. I wouldn't go anywhere else."
- Deborah N., Facebook Review
"Dr. Huffman is by far the best spine surgeon for so many reasons. I have worked for him, with him and been apart of his surgeries with assisted fluoroscopy. He is brilliant, dedicated and really cares about his patients. That said why would anyone go anywhere else. Did I mention he loves gummy bears, who doesn't love that."
- Sheila B., Facebook Review