Anterolisthesis

A form of Spondylolisthesis, Anterolisthesis is essentially a misalignment of the spinal vertebrae, referring to the anterior displacement (forward slip) of the vertebral body in the spinal column.

lumbarThe spinal column itself consists of 33 individual vertebrae stacked upon one another, it supports the weight of the body, allows movement and protects the fragile spinal cord. In between each vertebra is enough space to allow nerves to exit the spinal column and innervate other areas of the body. Anterolisthesis occurs when the vertebra body (the thick drum shaped area in the front of the vertebra) slips down onto the bone beneath. This slippage is graded on a scale of 1 – 4, with 4 being the most severe and 1 the least.

Anterolisthesis can occur anywhere in the body, but usually transpires in the lumbar region typically between the 4th and 5th lumbar vertebrae.

Causes

Severe impact to the spinal column and vertebral fracture, often as a result of trauma or injury from engaging in strenuous sporting activities such as weight lifting or gymnastics, as well as falls, vehicle collisions and other such accidents.

Anterolisthesis is often seen in the elderly due to degenerative changes, conditions such as arthritis may affect the alignment of the spinal column.

Genetics can also play a part, birth defects in the spinal column can result in anterolisthesis even in children, and in some cases the growth of a tumour can provoke the forward slippage of a vertebra.

Typical Symptoms

Lower back pain felt at the source, or radiating to other areas of the back is one of the most common complaints. Any pain experienced will very much depend on if the slippage has resulted in nerve compression, and if so, to what degree.

Nerve compression may cause varying symptoms depending on where it occurs, ranging in severity from mild to severely debilitating pain.

Symptoms may include:

  • sharp pain
  • numbness
  • difficulty walking
  • muscle spasms
  • postural issues
  • limited body movement
  • loss of bladder/bowel control
  • loss of sensations – the ability to feel hot or cold

Diagnosis

A history of the patient, detailing any physical impact which may have occurred. XRay testing is useful to illustrate vertebral fracture if this is suspected. MRI and CT scans will be helpful in highlighting nerve compression.

Grading

If there is a clear diagnosis of anterolisthesis, it will be graded on the following scale:

Grade 1 – 25% slippage

Grade 2 – 26 – 50% slippage

Grade 3 – 51 – 75% slippage

Grade 4 – 76 – 100% slippage

Treatment

Conservative methods are usually the first line of treatment.

Rest

Resting and avoiding sporting activities can help prevent further damage and help in the healing process.

Pain Relief Medication

Over the counter medication can provide effective relief for mild to moderate pain. In cases where severe nerve compression has occurred, stronger medication may be prescribed such as steroids or opioids.

Physiotherapy

Specific exercises and stretches can be highly beneficial in the treatment of anterolisthesis, helping to strengthen the surrounding muscles, improve mobility and reduce painful symptoms.

Surgery

In more severe cases, surgery may be considered if all other options have failed. This may be to reduce nerve compression, or by using internal fixation to stabilise the spine.

Pain Management

Anterolisthesis is a complex condition – the multi-disciplinary approach of the Pain Management clinic can provide effective management and treatment, working with patients on an individual basis to provide a tailored treatment plan.

Nerve Pain

nerve pain

Back Pain

back pain

Treatments

pain treatment