Spondylosis & Spondylolisthesis - Understanding and Optimsing Spinal Health

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Our spine is a complex structure of small bones (vertebrae), ligaments, nerves and connective tissue that supports movement, stability, mobility, and flexibility. But just like any structure, it can experience structural changes, resulting in issues that can detrimentally impact our day-to-day activities. Spondylosis and spondylolisthesis are two such conditions that can adversely affect and limit a person’s physical activity. This article examines these conditions more closely.

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What is Spondylosis/Spondylolisthesis?

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Spondylolisthesis is a Latin term meaning "slipped vertebral body." Spondylolisthesis is caused by one vertebra slipping forward over the vertebra that lies beneath it. Degenerative spondylolisthesis is frequently associated with the spine's normal aging process. It is generally more prevalent in the lumbar spine, which is the lower back.

On the other hand, spondylosis describes the gradual degeneration of the spine caused by wear and tear in the facet joints and intervertebral discs, that results in pain and stiffness.

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What is the Difference Between the Two?

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Spondylolisthesis typically occurs in the lower back, particularly at the junction between the lumbar spine and the sacrum (L5 over S1), though it can occur higher up as well. It's categorized into different types based on its cause:

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1. Congenital or Dysplastic
   
2. Isthmic
   
3. Degenerative
   
4. Traumatic
   
5. Pathologic
   

Killian coined the word "spondylolisthesis" in 1854 to refer to the progressive slippage of the L5 vertebra. The severity of this problem varies; some people with substantial slippage may have no symptoms at all, while others may have discomfort, nerve compression, or difficulty with walking.

Spondylosis on the other hand is typically characterized by a degenerative changes (stress fracture) in the pars interarticularis, meaning one of the vertebrae has weakened.  Children and younger individuals who play sports such as football or gymnastics, which repeatedly strains the lower back(particularly repeated extension), frequently exhibit spondylosis. As a result, spondylosis can weaken spinal structures, making individuals more prone to developing spondylolisthesis over time.

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Grading Scale

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The degree of vertebral slippage in spondylolisthesis is graded using a system called Meyerding's classification. This technique assesses the level of upper vertebral body advances relative to the lower vertebral body, to classify the degree of slippage.

- Grade 1: The amount of forward slipping is less than 25%.

- Grade 2: The spinal body has slid forward by 26% to 50%.

- Grade 3: The vertebral body has slid forward by 51% to 75%.

- Grade 4: There is a 76% to 100%forward slippage of the vertebral body.

This grading system aids a more precise determination of the degree of spondylolisthesis to decide the best course of action for either conservative or surgical treatment.

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Anatomy

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An explanation of lumbar spine structure is useful for understanding these disorders.

Intervertebral discs, which serve as shock absorbers and provide mobility, separate the five vertebrae numbered L1to L5, that collectively make up the lumbar spine. These vertebrae are the largest of the spine bones. Facet joints, also called zygapophyseal joints, are located at the back of each vertebra and help to support and promote movement of the spine. Strong fibrous bands known as ligaments attached to the vertebrae provide support by stabilising the spine and protecting the discs.

The three major spine ligaments are the legamentum flavum, anterior longitudinal ligament (ALL) and posterior longitudinal ligament (PLL).  The latter two are continuous bands that run from top to bottom of the spinal column along the vertebrae to prevent excessive movement of vertebral bones.  Spondylolisthesis and instability may be linked to ligamentous instability or degeneration. Research notes that accompanying lumbar extensor muscle weakness and dysfunction are often evident in findings of lumbar spondylosis in individuals.

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What are the Risk Factors?

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Several factors contribute to the development of spondylolisthesis, and certain groups are at higher risk.

1. Youth Athletes: Young athletes are more likely to develop spondylolisthesis, particularly in sports like football or gymnastics that require repetitive lumbar spine extension. Growing spurts are typically associated with vertebral slippage, and one of the main reasons why teenagers experience back pain.

2. Genetics: Individuals with isthmic spondylolisthesis are born with pars interarticularis, a thinner region of the vertebra. This increases the likelihood of fracture and slippage in this thin segment of bone, which connects the facet joints and facilitates spinal movement.

3. Age: Degenerative spine disorders are more common in older people when gradual weakening of the vertebrae occurs from repetitive stress on the spine. After the age of 50, spondylolisthesis becomes more common, indicative of the compound effects of age on spinal health.

4. Occupational & Lifestyle Factors: Jobs that require repetitive spinal loading, heavy lifting, or extended sitting periods can induce excessive strain on the spine and increase the likelihood of vertebral slippage.

Signs & Symptoms

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These pathologies can cause discomfort, decrease range of motion, and neurological abnormalities:

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Cervical Spondylosis:

• Neck pain & stiffness
• Cervical radiculopathy
• Cervical myelopathy

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Lumbar Spondylosis:

• Low back pain
• Leg pain (sciatica)
• Muscle spasms
• Difficulty standing/walking
• Numbness/weakness

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Some individuals with spondylosis and spondylolisthesis may not exhibit any symptoms with conditions found unintentionally through diagnostic imaging.

Early Phase Management

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Assessment of the degree of degenerative changes or spinal displacement using diagnostic imaging, such as MRI scans and X-rays, aids in the appropriate diagnosis of these conditions. For individuals with symptoms and pain, the first phase is to manage pain and adjust activities to temporarily reduce spinal loading.  

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GymTherapy deploys a range of therapies to address spinal issues with the goal of returning to well-being and ease of movement. These include rehabilitative strength and stability training, mechanics optimisation, postural correction and proprioception enhancement.

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Injury Prevention

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For high-risk individuals, preventive actions to reduce the impact of spondylosis and spondylolisthesis is important for quality of life. Implementing ergonomic principles into everyday tasks, regular exercise and strength training are all important to promote spine health.

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To Finish

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Although spondylosis and spondylolisthesis can have a negative health effect on individuals, early intervention can lessen and ameliorate symptoms. Our goal at GymTherapy is to offer complete care for the diagnosis and management of spinal pain. We do this by employing evidence-based individualised therapies to help you take charge of your healing process.

If you are experiencing symptoms and are dealing with pain or discomfort, consider a physiotherapy consultation for tailored guidance and treatment.

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References

1. Kalichman, Leonid, and David J Hunter.“Diagnosis and conservative management of degenerative lumbarspondylolisthesis.” European spinejournal : official publication of the European Spine Society, the EuropeanSpinal Deformity Society, and the European Section of the Cervical SpineResearch Society vol. 17,3 (2008): 327-335. doi:10.1007/s00586-007-0543-3
2. Middleton,K., Fish, D.E. Lumbar spondylosis: clinical presentation and treatmentapproaches. Curr Rev Musculoskelet Med2, 94–104 (2009). https://doi.org/10.1007/s12178-009-9051-x
3. ‍Zukowski,Lisa A et al. “The influence of sex, age and BMI on the degeneration of thelumbar spine.” Journal of anatomyvol. 220,1 (2012): 57-66. doi:10.1111/j.1469-7580.2011.01444.x
4. Brooks, Benjamin K et al. “Lumbar spine spondylolysis in the adult population:using computed tomography to evaluate the possibility of adult onset lumbarspondylosis as a cause of back pain.” Skeletalradiology vol. 39,7 (2010): 669-73. doi:10.1007/s00256-009-0825-4
5. Franz, Eric W et al. “Patient misconceptions concerning lumbar spondylosisdiagnosis and treatment.” Journal ofneurosurgery. Spine vol. 22,5 (2015): 496-502.doi:10.3171/2014.10.SPINE14537
6. Makhsous,M., Lin, F., Bankard, J. et al.Biomechanical effects of sitting with adjustable ischial and lumbar support onoccupational low back pain: evaluation of sitting load and back muscleactivity. BMC Musculoskelet Disord10, 17 (2009). https://doi.org/10.1186/1471-2474-10-17

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