About Degenerative Spondylolisthesis
Spondylolisthesis is Latin for “slipped vertebral body,” and is diagnosed when one vertebra slips forward over the one below. Degenerative spondylolisthesis may occur as part of the normal aging process of the spine. It may alter normal spinal alignment. Degenerative spondylolisthesis typically occurs in the lumbar spine (low back). In most cases, the L4-L5 spinal segment is affected, followed by the L3-L4 and L5-S1 spinal segments
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About Acute Neck Pain
Acute neck pain typically develops after a strenuous or jarring event, but may also present without any clearly related activity. An acute episode lasts for up to six weeks in patients without a history of complaints to the affected region, and symptoms can vary significantly between patients.
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The pain can be diffuse or focal and can feel like burning, a sharp discomfort, or a dull ache. The onset may be sudden but can also develop over a more extended period and may fluctuate in severity. Some cases will resolve spontaneously without additional care, but others require corrective procedures to restore function and alleviate discomfort.
Degeneration of the spinal discs
Loss of resilience and strength in the ligaments responsible for spinal stability
Osteoarthritis of the facet joints that connect the vertebrae, resulting in less support for the spinal segment
Inadequate muscle stabilization
How Degenerative Spondylolisthesis Develops
Spondylolisthesis develops due to degeneration at a spinal motion segment, which comprises a 3-joint complex. This 3-joint complex includes:
A disc in the front, which acts as a shock absorber between adjacent vertebrae (bones that make up the spinal column)
A pair of facet joints in the back, which allow limited motion. The facet joints may bear weight and limit spinal forward bending (flexion), backward bending (extension), rotation, and side-to-side motion.
Aging-related degeneration of the facets and discs may make them less able to bear loads, resulting in vertebral slippage in load-bearing segments of the lower spine.
2 Types of Vertebral Slippage in Degenerative Spondylolisthesis
Vertebral slippage in degenerative spondylolisthesis can happen in two ways :
Symmetrically, if both facets are equally affected and degenerated. In this case, the vertebra slips forward horizontally in a symmetrical manner.
Asymmetrically, where one facet is more degenerated than the other, causing the slippage to occur asymmetrically, which usually results in rotation.
In either case, the spinal disc also slips forward along with the vertebra.
Degenerative spondylolisthesis commonly occurs in the low back and is relatively rare in other parts of the spine. The condition may occur in the neck (cervical spondylolisthesis) due to degenerative changes in the cervical facet joints.
Degenerative spondylolisthesis causes pain through one or more of the following processes 3 :
Joint pain: Degeneration of facet joints causes inflammation of the cartilaginous facet joint lining
Soft tissue pain: Tension within the capsule and ligaments that surround the facet joints as the vertebra slips
Muscle pain: Spasm of the muscles that support the affected spinal segment
Stenosis pain: Narrowing of the central canal (spinal stenosis) and/or intervertebral foramen (foraminal stenosis) causing compression of the neural elements
These processes can result in some combination of localized back pain, sciatica, lumbar radiculopathy, and/or neurogenic claudication.
Can Acute Neck Pain be dangerous?
Generally, most processes involved in acute cases are benign, however, rarely an underlying pathology may be involved. These cases are prone to occur in individuals over the age of 50, and may include cancer or infectious etiologies. Symptoms to watch out for include fever, severe pain at rest, severe pain in the legs, bladder or bowel problems, or pain lasting more than six weeks, among others. In these situations, medical evaluation is strongly recommended.
When Degenerative Spondylolisthesis Is Serious
Degenerative spondylolisthesis is typically not a serious condition. The condition can become a medical emergency or require urgent care if it progresses to an extent that crucial spinal nerves are involved, or the stability of the affected segment is compromised.
In such cases, it is important to be able to identify the warning signs and symptoms of degenerative spondylolisthesis to ensure prompt medical attention and appropriate treatment.
Serious symptoms and signs are described below.
Progressive pain and weakness
It is important to seek immediate medical attention if there is persistent or worsening pain in the lower back that interferes with daily activities. The pain may radiate into the buttocks, thighs, or legs and may be accompanied by numbness, tingling, or muscle weakness. Additionally, any concerning progression of neurological symptoms, such as muscle weakness or loss of sensation should be evaluated by a physician urgently.
Changes in bowel or bladder function
Any changes in bowel or bladder function, such as difficulty controlling or emptying the bladder, bowel incontinence, or numbness in the genital area, is a medical emergency. These symptoms may indicate severe progression of spondylolisthesis leading to a serious condition known as cauda equina syndrome, which requires urgent surgical intervention.
Significant loss of function or mobility
Functional disabilities, such as difficulty walking, maintaining balance, or performing basic movements, may indicate a more advanced stage of the condition that requires prompt medical intervention.
Any of these issues are potentially serious and warrant immediate medical attention.
A specialist with advanced training in spine care can help evaluate and diagnose degenerative spondylolisthesis. Receiving personalized treatment at an early stage of the condition can help manage pain, prevent further complications, and enhance the overall quality of life for individuals with degenerative spondylolisthesis.
How is Acute Neck Pain managed?
Management of neck pain usually involves continuing with normal daily activities, though modifications are sometimes required to minimize pain or exacerbation of injury. The temptation is often to limit entirely usage of the painful structures, but this can lead to maladaptive behaviors, and will slow the healing process. Movement pumps blood flow over injured regions, and supports them with crucial healing factors. Pain can also be further managed with NSAIDs or other pain relievers, and warm or cold compresses.
For acute and sometimes chronic pain primarily in the back or neck it’s very reasonable to seek care from one of our spine physical therapists. For many insurances, referrals are not required. Dr. Paul’s team works closely with the therapists. They often facilitate referrals to Dr. Paul and his spine surgery partners.
About Physical Therapy
For acute and sometimes chronic pain primarily in the back or neck it’s very reasonable to seek care from one of our spine physical therapists. For many insurances, referrals are not required. Dr. Paul’s team works closely with the therapists. They often facilitate referrals to Dr. Paul and his spine surgery partners.
Diagnosis of Degenerative Spondylolisthesis
A physician trained in musculoskeletal conditions can help diagnose degenerative spondylolisthesis.
A comprehensive assessment of the patient’s history, past medical history, thorough physical examination, and review of any prior tests and imaging studies are performed.
During the review of patient history and the physical examination, physicians typically check for :
Pain pattern. Physicians ask about localized or radiating pain and the pattern of pain distribution to check if sciatica is present.
Postural effects. In degenerative spondylolisthesis, pain is exacerbated while bending backward and relieved when bending forward.
History of symptoms. Neurogenic claudication and hamstring spasm while walking or standing for variable periods of time may indicate spinal stenosis caused by degenerative spondylolisthesis.
If these symptoms and signs are noticed, the physician may order imaging tests to further investigate the condition.
Imaging tests may help confirm the diagnosis of degenerative spondylolisthesis and provide evidence of the extent of progression of the condition.
Standing lateral radiographs are considered the most reliable and standard test for diagnosing degenerative spondylolisthesis.
Flexion-extension radiographs are used to determine if there is any motion of one vertebra upon the other (translation) and/or instability during spinal movements.
Magnetic resonance imaging (MRI) scans may be used to check for spinal stenosis, nerve root compression, spinal cord involvement, and disc degeneration. Some researchers consider MRI scans as the most reliable test to diagnose spinal stenosis in degenerative lumbar spondylolisthesis.
CT scans are used if bone involvement such as spondylolysis or isthmic spondylolisthesis is suspected, as these scans provide detailed evaluation of bone integrity.
If an MRI is not possible, computed tomography (CT) scans with myelography may be used as an alternative test.
MRI scans or CT scans may also be used if severe neurogenic claudication is present, bowel and/or bladder incontinence is reported, and/or tumors are suspected.
How is Acute Neck Pain diagnosed?
The diagnostic modality of choice is x-ray imaging to give the physician a full view of the back and neck structures, though in many cases imaging is not even required. A doctor can usually make the diagnosis with only the physical examination and patient history, but in some cases further diagnostics will be ordered to exclude more concerning possibilities. The primary goal of treatment for acute neck pain is to resolve the episode as quickly as possible and return the patient to prior functioning.
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The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only. Dr. Paul makes no representation and assumes no responsibility for the accuracy of information contained on or available through this web site, and such information is subject to change without notice. You are encouraged to confirm any information obtained from or through this website with other sources, and review all information regarding any medical condition or treatment with your physician. NEVER DISREGARD PROFESSIONAL MEDICAL ADVICE OR DELAY SEEKING MEDICAL TREATMENT BECAUSE OF SOMETHING YOU HAVE READ ON OR ACCESSED THROUGH THIS WEB SITE.
Dr. Paul does not recommend, endorse or make any representation about the efficacy, appropriateness or suitability of any specific tests, products, procedures, treatments, services, opinions, health care providers or other information that may be contained on or available through this web site. DR. PAUL IS NOT RESPONSIBLE NOR LIABLE FOR ANY ADVICE, COURSE OF TREATMENT, DIAGNOSIS OR ANY OTHER INFORMATION, SERVICES OR PRODUCTS THAT YOU OBTAIN THROUGH THIS WEB SITE. www.paulspine.com/legal/disclaimer.
Individuals’ outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics and/or surgeon experience.
All logos and names are trademarks or registered trademarks of their respective owners.
©2024 Ronjon Paul MD. All rights reserved.
Disclosures & Important Information
The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only. Dr. Paul makes no representation and assumes no responsibility for the accuracy of information contained on or available through this web site, and such information is subject to change without notice. You are encouraged to confirm any information obtained from or through this website with other sources, and review all information regarding any medical condition or treatment with your physician. NEVER DISREGARD PROFESSIONAL MEDICAL ADVICE OR DELAY SEEKING MEDICAL TREATMENT BECAUSE OF SOMETHING YOU HAVE READ ON OR ACCESSED THROUGH THIS WEB SITE.
Dr. Paul does not recommend, endorse or make any representation about the efficacy, appropriateness or suitability of any specific tests, products, procedures, treatments, services, opinions, health care providers or other information that may be contained on or available through this web site. DR. PAUL IS NOT RESPONSIBLE NOR LIABLE FOR ANY ADVICE, COURSE OF TREATMENT, DIAGNOSIS OR ANY OTHER INFORMATION, SERVICES OR PRODUCTS THAT YOU OBTAIN THROUGH THIS WEB SITE. www.paulspine.com/legal/disclaimer.
Individuals’ outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics and/or surgeon experience.
All logos and names are trademarks or registered trademarks of their respective owners.
©2024 Ronjon Paul MD. All rights reserved.