Spondylolisthesis in the NeckPresentation Transcript
Spondylolisthesis in the Neck
Spondylolisthesis in the Neck Spondylolisthesis in the neck occurs far less frequently than spondylolisthesis in the lower back. However, spondylolisthesis in both regions of the spine can result in similar symptoms and can typically be treated using the same methods. Spondylolisthesis may require surgical treatment if spinal stability is compromised, but most minor cases can be treated without the need for surgery.
What is Spondylolisthesis? Spondylolisthesis in the neck or lower back occurs when a vertebra, one of the bone structures that sheathe the spinal cord, slips forward and over the vertebra directly beneath it. This typically occurs as a result of the degenerative changes that occur as an individual ages. These changes, which primarily affect the facet joints and intervertebral discs, can lead to spinal instability and, in turn, the development of spondylolisthesis. When the condition is diagnosed, it is assigned a grade to indicate the extent to which the vertebra has slipped out of place. The spondylolisthesis grades are assigned as follows:• Grade 1 – Less than 25 percent slippage• Grade 2 – Between 25 and 50 percent slippage• Grade 3 – Between 50 and 75 percent slippage• Grade 4 – Between 75 and 100 percent slippage• Grade 5 – The vertebra has completely slipped over the one beneath it As a general rule, the more the affected vertebra has slipped out of place, the more severe the patient’s symptoms. Many individuals with Grade 1 spondylolisthesis experience no symptoms at all, as minor cases of the condition often do not cause neural compression. Higher-grade spondylolisthesis, on the other hand, can cause severe pain, numbness, tingling, and muscle weakness in the limbs, as well as visible deformities.
How is Spondylolisthesis Diagnosed? The diagnostic process for spondylolisthesis in the neck or lower back usually begins when a patient visits his or her primary care physician with complaints of chronic back or neck pain. To determine the root cause of the patient’s problem, the physician will employ a number of diagnostic techniques, such as: • A question and answer session – The physician will ask the patient a number of questions pertaining to his or her symptoms and overall level of health. The doctor will likely ask what the patient’s symptoms are, how long they have been experiencing them, and if any activities either exacerbate or relieve them. The patient will also be asked about his or her medical history and whether any members of their immediate family suffer or have suffered from any spinal conditions. • A physical exam – Though somewhat uncomfortable for the patient, a physical exam is often essential to making a spondylolisthesis diagnosis. The physician will palpate the patient’s neck or back to determine if there are any tender or inflamed areas and to feel for any obvious deformities. The patient’s reflexes will also likely be tested to assess the extent to which the nervous system is associated with his or her neck or back pain. • Diagnostic imaging – When determining whether a patient has spondylolisthesis in the neck or lower back, diagnostic imaging is often required. The physician may order an X-ray, MRI, or CT scan to view the anatomical structure of the patient’s spine so vertebral slippage can be detected.
Medication for Spondylolisthesis in the Neck or Lower Back The symptoms of low-grade spondylolisthesis can sometimes be managed through the use of medication. Most physicians will initially advise their patients to take over-the-counter medications, such as nonsteroidal anti-inflammatory drugs like ibuprofen, or analgesics like acetaminophen. If these medications prove ineffective, some physicians may prescribe other drugs, such as:• Muscle relaxants – These drugs, which are also sometimes referred to as spasmolytics, serve to relax the muscles, in turn relieving muscle spasms and easing pain. The Food and Drug Administration (FDA) does not recommend long- term use of muscle relaxants, but they can be used to relieve the symptoms of spondylolisthesis in the neck or back over a short period of time. Examples of prescription muscle relaxants include carisoprodol, methocarbamol, and metaxalone.• Opioids – By bonding to the opioid receptors in the central nervous system, opioids can relieve acute and chronic pain. This class of medication has a high addiction rate, making many physicians hesitant to prescribe them. However, opioids are sometimes prescribed for patients who have debilitating pain or whose symptoms do not abate through the use of over-the-counter pain relievers. Examples of opioids include codeine, morphine, and hydrocodone.
Physical Therapy for Spondylolisthesis Many patients with spondylolisthesis in the neck or back benefit from working with a physical therapist to strengthen the muscles that support the spine. In turn, this can relieve some of the strain that is being placed on the vertebrae and may also help to ease some of the pressure that is being applied to the affected spinal nerve. In addition to strength training, physical therapy can also entail other treatment methods, such as posture modification exercises, transcutaneous electrical nerve stimulation (TENS), and massage therapy. Cryotherapy (the application of an ice pack or other cooling element) and thermotherapy (the application of a heat source) may also be utilized to reduce inflammation and relieve tense muscles, respectively.
Lifestyle Modifications Some of those who suffer from low-grade spondylolisthesis in the neck or lower back can relieve some of their discomfort by making certain lifestyle modifications. This is especially true of overweight individuals, whose spines are placed under added strain. Losing weight can help to relieve some of the pressure that is being applied to the spine’s anatomical components as well as to the spinal nerves that are being compressed. Other lifestyle modifications include:• Quitting smoking• Reducing alcohol consumption• Eating a well-balanced diet• Having a regular, low-impact exercise routine• Improving posture when sitting, standing, lifting objects, and even sleeping
Surgery for Low-Grade SpondylolisthesisIn some cases, those who suffer from spondylolisthesis in the neck orlower back will not receive adequate relief from the use of conservativetreatments. These patients may be advised to consider surgicaltreatment, and some may be candidates for a minimally invasiveprocedure in lieu of open spine surgery. Performed on an outpatientbasis, these endoscopic procedures access the spine through an incisionthat is usually less than one inch long. The surgeon decompresses theaffected spinal nerve by removing a small portion of the lamina, which isthe plate of bone at the rear of a vertebral foramen (the spinal canal). Insome cases, the surgeon may also remove a small portion of theintervertebral foramen, which is the opening between adjacent vertebraethrough which the nerve roots branch from the spinal cord. Most patientsrecuperate from an endoscopic spine procedure within a matter of weeksand some even experience immediate relief from the symptoms ofspondylolisthesis.Before consenting to this, or any other type of surgicaltreatment, patients are encouraged to pursue a second or third opinion.Patients should also be 100 percent comfortable with the operation’sassociated risks before they consent to surgical treatment.