Cervical Spine Spondylolisthesis Causes, Treatment, And Surgical Options
Cervical Spine Spondylolisthesis Causes, Treatment, And Surgical Options
Spondylolisthesis surgery is normally considered the treatment of last resort for individuals who suffer from severe vertebral misalignment. This Cervical Spine Spondylolisthesis condition can develop as a result of a congenital defect, traumatic injury, or natural degeneration, and may result in a loss of spinal stability in advanced cases. In most instances, spondylolisthesis can be effectively managed with a conservative regimen of nonsurgical treatments, although for a select segment of the population, surgical procedures such as spinal fusion are required to achieve lasting relief and stability.
Cervical Spine Spondylolisthesis Explained
Cervical Spine Spondylolisthesis is a condition that occurs when one vertebra becomes misaligned in relation to the vertebrae above and below it. While this condition can conceivably happen anywhere in the spine, it is far and away most common in the lumbar spine in the lower back. This is because this region of the spinal column is extremely burdened by much of the body’s weight and is also highly flexible. This combination of weight burden and mobility makes degenerative spondylolisthesis quite common in individuals over the age of 50. As an individual ages, years of wear and tear cause the anatomical components of the spinal column to naturally begin to deteriorate. The intervertebral discs that cushion and separate the vertebrae become worn and weakened, the vertebral facet joints that connect adjacent vertebrae become arthritic and swollen, muscles weaken, ligaments calcify, and other changes occur. Degenerative spondylolisthesis often follows the onset of degenerative disc disease or facet disease, and occurs when one vertebra shifts out of its proper place.
Alternatively, isthmic spondylolisthesis is also quite common in the lumbar spine, but for slightly different reasons. This type of spondylolisthesis usually develops as a result of an injury to the spinal column that develops as a result of repetitive mechanical movements and is the most common form of spondylolisthesis prior to middle age. Traumatic injuries, such as those incurred from a car accident or fall can certainly damage the vertebra and lead to spondylolisthesis, but this is less common than stress fractures from repetitive strain. Athletes who participate in high-impact sports such as football, soccer, gymnastics, and hockey often develop stress fractures in the pars interarticularis and other areas of the vertebrae that can lead to vertebral misalignment. Spondylolisthesis may also be caused by a spinal defect that develops in utero and can lead to back pain and even severe spinal deformity in adolescents.
Cervical Spine Spondylolisthesis Grades
That being said, it is important to understand that spondylolisthesis is typically described in various “grades” of severity and isn’t always symptomatic or problematic.
- In early stages (Grades I and II) spondylolisthesis may cause back stiffness, soreness, intermittent pain, and other generally mild symptoms that can often be confused with a minor strain or sprain, or it may go completely undetected – at least at first.
- More severe cases of spondylolisthesis (Grades III & IV) may eventually cause spinal deformity, chronic pain, neuropathic symptoms, and even a loss of spinal integrity.
Non-Surgical Cervical Spine Spondylolisthesis Treatment Options
Before spondylolisthesis surgery is considered, most doctors will first attempt to manage the patient’s symptoms with noninvasive techniques, assuming the patient’s condition isn’t advanced or causing debilitating and severe symptoms. Oftentimes, spondylolisthesis is a result of excessive pressure being placed on the spinal column, so many conservative treatments are designed to alleviate this pressure. However, the specific treatments recommended will vary from patient to patient depending on the specific cause of the spondylolisthesis, as well as other pertinent variables such as the patient’s age and health, the extent of the misalignment, the symptoms that the patient is experiencing, and more.
That said, some of the more commonly recommended nonsurgical treatments for spondylolisthesis include:
- Nonsteroidal anti-inflammatory drugs
- Pain medication
- Muscle relaxants
- The application of heat to reduce inflammation or ice to reduce swelling
- Low-impact exercises, such as walking, jogging, or swimming
- Stretching techniques such as yoga or Pilates
- Alternative medicines, including deep tissue massage, chiropractic therapy, and acupuncture
- Limited rest
- A healthy diet
- Posture improvement
- And other lifestyle changes
This course of treatment is often effective for managing back pain, numbness, tingling, muscle weakness, and the other symptoms that are most commonly associated with low-grade spondylolisthesis. However, with a select segment of the population, conservative treatments fail to provide sufficient relief, in which case more advanced techniques may be recommended.
Cervical Spine Spondylolisthesis Surgery Historically
The most popular and oft-recommended type of spondylolisthesis surgery has been a procedure known as spinal fusion. During this highly invasive procedure, the vertebrae are realigned properly and fused together to promote stability and remove the source of the patient’s chronic symptoms.
A patient who is scheduled to undergo spinal fusion must first be admitted to a hospital and then administered general anesthesia by a certified anesthesiologist. Once sedated, a team of orthopedic surgeons accesses the affected region of the spinal column through an incision several inches in length. Once the surgeons are in position, the intervertebral disc is carefully removed and replaced with a bone graft, matrix, or in some cases, an artificial disc. Surgical hardware consisting of rods and screws are also installed to further support the spine. The surgical procedure is completed, the incision closed, and the patient is transferred to recovery. In most cases, the patient should plan on staying in the hospital for several days after the operation for observation.
Cervical Spine Spondylolisthesis Surgery Complications
Clearly, this is a highly invasive procedure, and the decision to undergo spondylolisthesis surgery should not be taken lightly. As with any major surgery, spinal fusion comes with a significant risk for post-operative complications that should be fully weighed before consenting to the operation.
These risks include:
- Scar tissue build-up
- Failed back surgery syndrome (FBSS)
The chance of developing failed back surgery syndrome is particularly troublesome because this entails the continuation or worsening of symptoms after the surgery has been completed and can be traced to everything from doctor error to graft rejection and the failure of the patient to complete rehabilitation.
Endoscopic Spine Surgery
Is Cervical Spine Spondylolisthesis Surgery The Right Option For Your Case?
While spinal fusion surgery is the preferred treatment of choice for patients with severe cases of Cervical Spine Spondylolisthesis, occasionally an endoscopic alternative may be considered. These minimally invasive, outpatient procedures are not intended to stabilize the spine, but in instances where low-grade spondylolisthesis is causing nerve compression within the spinal column, this course of treatment may provide sufficient relief. Unlike spinal fusion, endoscopic procedures usually require only local anesthesia and IV sedation and are completed in a matter of hours using state-of-the-art laser technology and other advanced surgical tools. Additionally, recovery and rehabilitation from an endoscopic procedure are far less intensive than with open spine surgery.
The thing to realize is that while endoscopic surgery may not be right for everyone, there are a variety of spondylolisthesis treatments to consider. One should never feel pressured to consent to any course of treatment that they are not completely comfortable with, nor should they resign themselves to one doctor without receiving a second or even third opinion. The chronic symptoms associated with spondylolisthesis, to say nothing of the risk for spinal deformity, are too significant to take lightly. Be diligent, research your treatment options, and don’t be afraid to ask questions.
To learn more about Cervical Spine Spondylolisthesis surgery and the other treatments currently available, visit a spine specialist or general practitioner today.