During the normal aging process joints in the spine will be less stable, the disc will be degenerated and one
vertebra may slip forward over the other one below. This is called degenerative spondylolisthesis and is
approximately four times more common in women than in men and is also more frequent in diabetics.
The slip generally occurs most often in the lower back, specifically between the 4th and 5th lumbar vertebrae.
This slip can narrow the spinal canal and place pressure on the nearby nerve roots, leading to pain down into
the legs. Low back pain, however, is the most common symptom and is aggravated by heavy lifting and
bending. A plain X-ray will most often lead to the diagnosis. In the beginning, however, the degeneration of the
disc and the slip can be very discreet. This syndrome is often named degenerative disc disease The disc
degeneration can be seen in MRI and discography. The instability of the spine may lead to facet syndrome,
intervertebral joint irritation with attacks of locking of the facet joints. The patient can experience attacks of
back pain, numbness of the legs and feet, voiding problems, faintness and nausea. It can be most distressing
when nobody can understand your trouble. Degenerative spondylolisthesis associated with low back pain is
treated non-operatively. During a more acute phase non-steroidal anti-inflammatory drugs (NSAIDS) are
prescribed. Anti-depressent drugs have analgesic properties and may improve sleep. A brace is designed to
reduce the loads to the lumbar spine. Manipulation has been shown to be effective during the first month of
back pain without radiculopathy. Physical therapy may be added to the treatment plan to help improve
muscular endurance, coordination, strength of abdominal musculature and facilitate weight loss.
For severe acute radiculopathy associated with degenerative spondylolisthesis, epidural steroid injections can
be beneficial, although they are not usually effective in relieving the low back pain component. Surgical
intervention is indicated if conservative therapy fails, if pain becomes disabling, a patient becomes unable to
function, or if a progressive neurological deficit exists. Age is not a contraindication to surgery as elderly
patients often benefit most from surgical intervention, as they are incapacitated by the stenosis and
degenerative spondylolisthesis because of a small physiological reserve. Operative intervention includes
decompression with or without fusion and possible instrumentation. The most basic fusion is a posterior fusion.
This procedure is done through the same incision as the decompression, and bone graft is taken from the bone
removed for decompression, the pelvic bone or donor bone. Instrumentation can be added such as titanium
screws and spacers to increase the fusion rate. Today there are many different methods of minimal invasive
surgery available, to minimise the operation trauma and permit early postoperative ambulation. If the
pathology of the spine is fairly localised and the adjacent joints looks all right, there is a good chance of
excellent outcome of surgery. Smoking cigarettes will inhibit the healing process and overweight increases
the risk of complications. In the next issue, I will describe a modern treatment for osteoporosis fractures and
degenerative scoliosis as a growing problem in the society. Feel free to ask the doctor about various problems
in spinal and orthopaedic surgery. The answers will naturally not be personal but for general knowledge. For a
thorough discussion and examination of your problems, please contact your own doctor.