Spondylolisthesis – a bit more about the signs and symptoms of Spondylolisthesis?

Spondylolisthesis
Spondylolisthesis

Spondylolisthesis

Spondylolisthesis is where a bone in the spine (vertebra) slips out of position, either forwards or backwards.

It’s most common in the lower back (lumbar spine), but it can also occur in the mid to upper back (thoracic spine) or the neck (cervical spine).

Spondylolisthesis isn’t the same as a slipped disc, which is where one of the spinal discs between the vertebrae ruptures.

Symptoms of spondylolisthesis

Many people may not realise they have spondylolisthesis because it doesn’t always cause symptoms.

Symptoms can include:

lower back pain – which is usually worse during activity and when standing, and is often relieved by lying down

pain, numbness or a tingling sensation radiating from your lower back down your legs (sciatica) – this occurs if the slipped vertebra presses on a nerve

tight hamstring muscles

stiffness or tenderness in your back

excessive curvature of the spine (kyphosis)

The severity of these symptoms can vary considerably from person to person.

What causes spondylolisthesis?

There are five main types of spondylolisthesis, each with a different cause. Spondylolisthesis can be caused by:

a birth defect in part of the vertebra – this can cause it to slip forward (dysplastic spondylolisthesis)

repetitive trauma to the spine – this results in a defect developing in the vertebra, which can cause it to slip; this is known as isthmic spondylolisthesis and is more common in athletes such as gymnasts and weightlifters

the joints of the vertebrae becoming worn and arthritic – this is known as degenerative spondylolisthesis and is more common in older people

a sudden injury or trauma to the spine – such as a fracture, which can result in the vertebra slipping forward (traumatic spondylolisthesis)

a bone abnormality – this could be caused by a tumour, for example (pathologic spondylolisthesis)

When to see your GP

You should see your GP if:

you have persistent back pain or stiffness

you have persistent pain in your thighs or buttocks

your back curves outwards excessively

Your GP may examine your back, although there aren’t usually any visible signs of spondylolisthesis.

Your GP may ask you to do a straight leg raise test, where you lie on your back while your GP holds your foot and lifts your leg up, keeping your knee straight. This is often painful if you have spondylolisthesis.

Spondylolisthesis can easily be confirmed by taking an X-ray of your spine from the side while you’re standing. This will show whether a vertebra has slipped out of position or if you have a fracture.

If you have pain, numbness, tingling or weakness in your legs, you may need additional imaging tests, such as a computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan. These more detailed scans will be able to help determine whether you have a compressed nerve in your back.

Treating spondylolisthesis

The way spondylolisthesis is treated will depend on your symptoms and how severe they are. In most cases non-surgical treatments will be recommended first.

Non-surgical treatments

Initial treatments for spondylolisthesis may include:

a short period of rest, avoiding activities such as bending, lifting, contact sports and athletics

anti-inflammatory painkillers, such as ibuprofen, or stronger painkillers available on prescription can help reduce pain and inflammation

physiotherapy – simple stretching and strengthening exercises may help increase the range of motion in your lower back and hamstrings

if you have pain, numbness and tingling in your legs, corticosteroid injections around the compressed nerve and into the spinal canal may be recommended

These measures will only provide temporary symptom relief, but your symptoms may disappear completely with time.

Back braces sometimes used to be recommended for some people with spondylolisthesis. However, there are concerns that bracing may actually weaken the spine and fail to improve symptoms.

Surgery

Surgery may be recommended if non-surgical treatments are ineffective and your symptoms are severe, persistent, or suggest you have a compressed nerve in your spine.

The exact surgical procedure you need will depend on the type of spondylolisthesis you have.

It usually involves fusing the slipped vertebra to the neighbouring vertebrae using metal screws and rods, and a piece of your own bone taken from an area nearby. The screws and rods are usually left in place permanently.

In some cases the spinal disc being compressed between your vertebrae may also be removed. It will be replaced by a small “cage” containing a bone graft to hold your vertebrae apart.

The operation is performed under general anaesthetic, which means you’ll be unconscious while it’s carried out.

Surgery is often effective at relieving many of the symptoms of spondylolisthesis, particularly pain and numbness in the legs.

However, it’s a major operation that involves up to a week-long stay in hospital and a recovery period lasting months, where you have to limit your activities.

Spinal surgery for spondylolisthesis also carries a risk of potentially serious complications, including:

infection at the site of the operation

blood clot developing in one of the veins in your leg – known as deep vein thrombosis (DVT)

damage to the spinal nerves or spinal cord, resulting in continuing symptoms, numbness or weakness in the legs, or, in rare cases, some degree of paralysis or loss of bowel or bladder control

Because of the possibility of complications, make sure you discuss the operation in detail with your doctor or surgeon before deciding to have surgery.

Read more about lumbar decompression surgery, a type of spinal surgery used to treat compressed nerves in the lower (lumbar) spine.

Marfan syndrome – what are the signs and symptoms of Marfan syndrome?

Marfan syndrome
Marfan syndrome

Symptoms of Marfan syndrome

Marfan syndrome can affect many parts of the body, including the skeleton, eyes, and heart and blood vessels (cardiovascular system).

The severity of the symptoms varies widely. Some people experience a few mild symptoms, whereas others – about 1 in 10 – experience more severe symptoms.

The symptoms of Marfan syndrome tend to get more severe as a person gets older.

Skeleton

Someone with Marfan syndrome may have several distinct physical characteristics. They may be:

tall and slim, with long, thin arms and legs

have loose and very flexible joints

If your child is particularly slim or tall for their age, it doesn’t necessarily mean they have Marfan syndrome. It’s a rare syndrome, and your child will usually have a number of other symptoms if they have it.

Other physical characteristics of Marfan syndrome can include:

a small lower jaw

a high, arched palate (roof of the mouth)

deep-set eyes

flat feet

a breastbone (sternum) that either protrudes outwards or indents inwards

crowded teeth

Scoliosis

Marfan syndrome can cause the spine to become abnormally curved to the sides. This is known as scoliosis.

Curvature of the spine can cause long-term backache. In severe cases, it can also make breathing difficult as the spine may press against the heart and lungs.

Spondylolisthesis

Spondylolisthesis is where one of the bones in your spine (a vertebra) slips forward over another vertebra.

This usually occurs in the lower spine, and can cause back pain and stiffness. Anyone can develop spondylolisthesis, but it more commonly affects people with Marfan syndrome.

Dural ectasia

The dura is the membrane that lines your brain and spinal cord. Dural ectasia is a condition where the dura becomes weakened and expands outwards.

People with Marfan syndrome are at particular risk of developing dural ectasia. As the membrane expands, it can press on the vertebrae in your lower back, which can cause:

backache

headache

numbness or pain in your legs

Eyes

Many people with Marfan syndrome have some type of vision problem.

Lens dislocation affects half of all people with the syndrome. This is where the eye’s lens, the transparent structure that sits behind the pupil and focuses light, falls into an abnormal position.

Other possible eye-related symptoms of Marfan syndrome include:

myopia – short-sightedness

glaucoma – increased pressure in the eyeball which, left untreated, can cause permanent vision loss

aortic anyurism – where cloudy patches develop in the eye’s lens, causing blurred or misty vision

retinal detachment – where the light-sensitive layer of cells at the back of your eye (retina) begins to pull away from the blood vessels that supply it with oxygen and nutrients

Cardiovascular system

Marfan syndrome can affect the cardiovascular system, which is made up of your heart and blood vessels. It’s particularly serious if your aorta and heart valves are affected.

Aorta

The aorta is the main artery in the body. It runs from your heart, down the centre of your chest, and through your abdomen.

In people with Marfan syndrome, the walls of the aorta are weak. This can sometimes cause the aorta to enlarge and balloon, which is known as an aortic aneurysm.

In severe cases, the aorta can split (rupture), causing potentially fatal internal bleeding.

Valves

Your heart has four chambers that pump blood to and from the rest of the body. To control the flow of blood through your heart’s chambers, your heart has four valves:

mitral valve

aortic valve

tricuspid valve

pulmonary valve

These valves act as one-way gates, allowing blood to flow through in one direction. In some people with Marfan syndrome, the mitral or tricuspid valves don’t close properly and blood leaks back through the valve.

Read more about common mitral valve problems.

The aortic valve may also leak, leading to the main pumping chamber (left ventricle) gradually becoming enlarged.

Monitoring

If your GP thinks you may have Marfan syndrome, you’ll be referred to a specialist for testing. Your heart and blood vessels will be examined for the symptoms of the syndrome.

Read more about diagnosing Marfan syndrome.

Stretch marks

Stretch marks are pink, red, or white streaks in the skin. They can appear when you gain or lose weight quickly, when you have a growth spurt during childhood, or during pregnancy.

People with Marfan syndrome often develop stretch marks because the tissue in their skin is weakened and the skin isn’t as elastic as it should be.

If you have Marfan syndrome, stretch marks are most likely to appear on your:

shoulders

hips

lower back

Over time, they’ll gradually fade to a silvery colour and will be difficult to see.