Anterolisthesis

Commonly known as spondylolisthesis, anterolisthesis is a spinal condition marked by forward sliding/displacement of the drum-shaped upper part of vertebral bone, which occurs in front of each vertebral bone, to the vertebra present below.  Patients may suffer from symptoms that are different and distinct from another patient. The symptoms are usually related to the location of the displacement and subsequent occurrence (or not) of nerve root pinching or narrowing.

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The percentage of displacement of the upper vertebra is graded on a scale of one to four, wherein Grade 1 is mild and marked by less than 25% dislodgement and Grade 4 is severe and marked by more than 75% displacement.

Symptoms

Anterolisthesis patients may experience the below listed signs and symptoms:

  • One of the most prevalent symptoms of anterolisthesis is pain in lower back.
  • The pain may be local to affected area or it may be extensive. Intense pain may be felt at the region with vertebral bone displacement.
  • Muscle spasms occur when the body makes adjustment to protect itself which successively worsens the intensity of pain. Muscle tightening caused by muscular spasms can cause severe inflammation and pain of tissues located near spinal disc, vertebral bones, and/or nerve roots. Eventually, patients may experience more frequent episodes of pain thus resulting in a nearly perennial state of pain with increasing levels of severity.
  • In some cases, pain may occur in one or both legs. Affected people may or may not additionally experience weakness and numbness. Anterolisthesis accompanied by weakness of muscles typically signifies severe nerve damage.
  • Excessive pain may pose problems in different body movements. Spread of the pain to the legs may lead to walking problems and/or imbalance or balance difficulties.
  • Depending on the prevalence and severity of pain and inflammation, different body movements may be seriously restricted. Patients may find it difficult to bend, twist, etc., if the back, buttocks, legs, or other body areas are inflamed and painful
  • Anterolisthesis of the vertebral bones in the lower back accompanied by problems of the cauda equina nerve roots may trigger loss of bladder and/or bowel control.
  • Some patients may suffer from tingling sensations in legs, numbness, etc.

Grading of anterolisthesis

The severity, extensiveness, and degree of anterolisthesis are graded after diagnosis as a percentage of forward sliding of vertebral bone. Presented below are the 5 grades of anterolisthesis:

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  • Grade I: It is mild and marked by 25% forward dislodgement/slippage.
  • Grade II: It is marked by 26% to 50% forward dislocation
  • Grade III: It is marked by 51% to 75% forward dislocation
  • Grade IV: It is rated as being very serious anterolisthesis and is marked by 76% to 100% forward dislocation.
  • Grade V: In this, there is complete dislodgement of the upper vertebral bone section, i.e., it gets completely removed from adjacent spinal bone

Causes of anterolisthesis

  • Any kind of forceful or heavy blow or impact on the C4/C5 vertebral bones or the spinal cord or different kinds of vertebral bone injuries can result in anterolisthesis. A few events that can cause such trauma include vehicular accidents, playing sports, and fall from a height, etc. Severe instances of anterolisthesis may be accompanied by fracture of bones located near the vertebral column.

In addition to above listed causes, anterolisthesis may also occur due to:

  • Development of spinal tumors
  • Hereditary triggers
  • Natural degeneration of bones occurs as people age or grow older. Such degenerated fragile bones are more prone to damage, fractures, and injuries. Hence, anterolisthesis is more common in elderly people.
  • Engaging in gymnastics, football, weight-lifting, or other such physically demanding activities can place excess strain on the spinal column and increase the risk of anterolisthesis. Athletes and sportspeople are thus at greater risk to developing the spinal condition.
  • People in occupations that demand extensive physical activity/labor are also more vulnerable than those with other jobs.
  • Poor posture, constant imbalance, or unstable core of body may trigger mechanical failure of the spinal cord or degenerative changes of the vertebral bones.

Treatment of anterolisthesis

Anterolisthesis is treated in the following ways:

  • For mild anterolisthesis, doctors will recommend lots of bed and avoiding strenuous physical work. Rest will facilitate natural healing and easement of inflammation and pain.
  • NSAIDs may be prescribed for relief from pain and inflammation. Chronic back pain can be alleviated with opioid drug therapy. Doctors may also prescribe medicines like muscle relaxants, anti-seizure pain medications, antidepressants, and oral steroids, etc.
  • Drug therapy may be accompanied by physical rehabilitation therapy for alleviating pain and enhancing core strength. Additionally, heat compresses, electrotherapy, and therapeutic workouts may also be advised for faster recovery.
  • Surgical removal of bone and tissue may be performed for easing pressure on the vertebral column and/or to fuse the spinal bones in their right place
  • Chiropractic treatment may also be given if varied factors like medical history of patient, etc., permit it.
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