Slipping Vertebrae Part 1
Q.What is Grade I spondylolisthesis? My primary-care provider referred me to a neurosurgeon. Do I really have to go down that road? I know that I basically have an anterior slip of L5 relative to L4, but I need to get back to work as soon as possible.
B.L.
A.Spondylolisthesis refers to a slippage of one vertebra on another. You can be born with it, or it can result from an accident, through degeneration of the tissue, or as a secondary effect of a bone disease. The prevalence in the population is about 5 percent and is the same for both men and women. The degree of slippage is graded. Grade I implies that less than 25 percent of the body has slid forward. Grade II implies 25-50 percent, grade III implies 50-75 percent, and grade IV is 75 percent and greater.
A.Surgery is not always necessary for spondylolisthesis. Often, restriction of activity, exercises for the spine and abdominal muscles, and use of anti-inflammatory medications as well as intermittent back bracing are enough to alleviate pain. In general, the younger the patient with spondylolisthesis, the better the chance that surgery will be beneficial.
Two different surgical procedures are available for spondylolisthesis. One is a decompressive type surgery, whereby the bone that is pressing on the nerve roots is removed, freeing up the nerve roots. The other procedure is fusion, whereby the bone from one vertebra is encouraged to grow into the other, preventing movement; hopefully this alleviates the pain and prevents any further progression. Fusion can be done with or without metal rods and plates.
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