What is Spondylolisthesis?
Spondylolisthesis is a condition wherein one spinal bone in the lower back slips forward on top of the lower one. Usually, it is L4 over L5 or L5 over S1.
What are the signs & symptoms of Spondylolisthesis?
These patients can develop back pain or develop pain in the legs as a result of pinching of nerves in the back consequent to the shifting of bones. In severe cases, patients find it difficult to stand or walk for more than 5-10 min, but sitting brings them immediate relief and they can walk again for a few minutes. This symptom is known as neurogenic claudication. In extreme cases, when there is a lot of nerve compression, patients can also develop weakness or paralysis in the legs or rarely even loss of bladder or bowel control.
What are the causes for Spondylolisthesis?
Degenerative Spondylolisthesis
This is the most common type of Spondylolisthesis. This occurs as a consequence of age related wear & tear in the facet joints and discs which results in instability between spinal bones, resulting in slippage of one bone on top of the other. It is most common at L4-5.
Isthmic Spondylolisthesis
Pars interarticularis is a very strong pillar of bone which acts as a stabilizing staructure or lock between spinal bones. Sometimes, this pars interarticularis develops a break or defect due to which the spine loses its stability resulting in slippage of one bone on another. The reason for this pars defect may be injury, repeated injury over a period of time as in sportspersons / athletes or due to anatomical predisposition since birth. This type is most common at L5-S1.
Iatrogenic Spondylolisthesis
Pars interarticularis is a very strong pillar of bone which acts as a stabilizing staructure or lock between spinal bones. Sometimes, this pars interarticularis develops a break or defect due to which the spine loses its stability resulting in slippage of one bone on another. The reason for this pars defect may be injury, repeated injury over a period of time as in sportspersons / athletes or due to anatomical predisposition since birth. This type is most common at L5-S1.
Pathological Spondyloisthesis
Sometimes, the stabilizing structures of the spine are damaged due to infection, tuberculosis or tumors or cancer. This can also cause spondylolisthesis.
Does Spondylolisthesis always need Spine Surgery?
If symptoms are mild to moderate, then Physiotherapy and exercises can help control the symptoms. But, if symptoms are severe or if the patient starts developing paralysis then a Lumbar Fusion operation using the Transforaminal Lumbar Interbody Fusion (TLIF) or MISS-TLIF approach will relieve the patient.
How is Spondylolisthesis Surgery done?
This operation is done from the back. In this operation, titanium screws are inserted in 2 spinal bones and the disc between them is taken out in entirety while protecting the spinal nerves. Then, a plastic cage filled with bone graft is packed in the place of the disc so that over a period of time, bone grows between the two bones and they become fused (joined) to each other. This eliminates any further risk of slipping and relieves the patient’s pain.
What to expect from a Spondylolisthesis Surgery in India?
The incision size is about 4-6 cm. The typical hospital stay for Lumbar Fusion is 3-4 days. You can expect to walk the next day after surgery. You will be pretty much independent by the time of discharge. Most patients are able to travel back to their country in about 10-14 days after their spinal fusion surgery. You can expect to join back work at 3-4 weeks. TLIF can be done by Minimally Invasive Spine Surgery [MISS-TLIF], using small cuts with no external stitches, thereby reducing the hospital stay and blood loss.
The success rate for a Lumbar Fusion is 99%. The approximate cost of a single level spinal fusion surgery at the best hospitals in India is approx. 6000 USD using American Implants.
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