Degenerative spondylolisthesis in the lumbar spine

The human spine is formed by individual vertebrae and connective tissue discs in between. The vertebrae form the spinal canal. There are seven cervical, twelve thoracic, and five lumbar vertebrae. The intervertebral discs are the link between the individual vertebral bodies.

The little joints that link the vertebrae together are known as facet joints. They help to stabilize the spine and, together with the intervertebral discs, allow a certain degree of mobility of the spinal cord. The spinal canal should be wide enough to allow nerve roots to float freely in cerebrospinal fluid. The front border of the spinal canal is built by the vertebral bodies and intervertebral discs, the side by the intervertebral joints (facets) and back by the ligamentum flavum (yellow band) and vertebral arches. Discs consist of an outer fibrous ring (annulus fibrosus), which surrounds an inner gel-like center (nucleus pulposus). The spinal cord and nerve roots lie within the spinal canal. The spinal cord extends downwards approx. to the 1st lumbar vertebra. Below, only nerve roots are present in the spinal canal. At the level of the intervertebral disc the nerve roots pass through the neural root foramina to exit the spinal canal. The spinal cord and nerve roots conduct electric-like signals from the skin and joints to the brain, and process of movement is initiated from the brain to the muscles.

Degenerative spondylolisthesis is a vertebral slip most common in the lumbar spine, most often at the level of L4/5. It is the result of degenerative changes in the intervertebral disc, joints and ligaments causing the vertebrae to slip forward. This type of spondylolisthesis is most common among female patients over the age of 60. Unlike all other types of spondylolisthesis the degenerative spondylolystesis usually does not cause symptoms. Very often associated with spinal canal stenosis.

Gradually progressing inflammation and degeneration in the intervertebral joints in the lumbar spine

Acute compression of a lumbar nerve root in the spinal canal

Patients usually have no symptoms related to a degenerative spondylolisthesis. In rare cases patients may expeprience:

Tingling, shooting pain or muscle weakness (paresis) of one or both legs

Pain and stiffness in the lower back Leg pain (pseudoradicular type)

The treatment may be non-surgical or surgical.

If degenerative spondylolisthesis is accompanied by symptomatic spinal canal or neuroforaminal stenosis, it is advisable to perform decompression at the affected level. Usually, no additional fusion is required. Among patients with degenerative lumbar spinal stenosis with spondylolisthesis, decompression surgery plus fusion surgery did not result in better long-term clinical outcomes than did decompression surgery alone (PMID: 27074066).

To release the compressed nerve roots

To improve symptoms (e.g. pain reduction)

To stop the worsening of the symptoms

Eliminate painful movement in the affected spinal segments

To preserve the protective function of the spine

Posterior decompression of the spinal canal without fusion

Posterior decompression of the spinal canal with stabilisation