What is Anterolisthesis?
The term anterolisthesis is derived from “ante”, a Latin word that means ‘front’ and “listhesis”, a Greek word that means ‘sliding down on a path that is slippery’. Putting the terms together, you will have “antelisthesis” that means a front slide down a path that is slippery. This is the reason why anterolisthesis refers to the condition of the spine in which the upper body of vertebral, the area shaped like drum at the front of each vertebrae slips forwards on to the vertebra.
The magnitude of slippage is graded by doctors in to scales from one to 1 to 4. In grade I1anterolisthesis, there is mild slippage that is less than 25%. In grade 2 anterolisthesis, the slippage is more than 25% but less than 50%. In grade III, the slippage is more than 50% but less that 75%. In grade IV, the slippage is more than 75%; it may even be 100% in some cases and the symptoms are usually very severe in this grade.
To get exactly what this term means it is also very good to understand the meaning of the term vertebra.Anterolisthesis Image
What is Vertebra?
The vertebra (singular) or vertebrae (plural) are those bones that form an opening in which the human spinal cord passes through. The vertebrae are positioned on top of one another like stacks. At the front part of each vertebra is a thick part of bone that is shaped like a drum and which is referred to as vertebral body.
Between every two vertebrae there are disks which are referred to as the intervertebral discs. The discs look like cushions and they are flat in shape. The main purpose of the intervertebral discs is that they absorb and protect the spinal cord and the vertebrae from shock.
In anterolisthesis, there is abnormal positioning of the upper vertebral body when compared to the body of the lower vertebra. As stated above, the upper vertebral body tends to slip in forward direction to the vertebra below it.
Causes of Anterolisthesis
Anterolisthesis is mainly caused by great impact on the spinal cord( anterolisthesis cervical spine or spondylosis) or the vertebra mainly the c4 and c5 ( anterolisthesis c4 c5) . It could be due to falls from high heights, bullet wounds, impact from vehicle collisions, injury from sporting activities, and such related events. In severe cases, the anterolisthesis is accompanied by the fracture of other bones that are adjacent to the spinal cord.
In the absence of fracture from sudden high impact, the condition may also be caused by core weakness, instability and/or poor posture. All these events will gradually lead to degenerative anterolisthesis changes or mechanical breakdown of the segment.
How can you avoid Anterolisthesis?
To avoid this condition, the persons at risk especially the older members of the society are advised to engage in exercises for anterolistheis and to maintain good body posture when sleeping, sitting and in other daily activities.
Symptoms of Anterolisthesis
The symptoms as of anterolisthesis may vary greatly because the intensity and severity of the same is dependent on the amount pinch that the slippage exerts on the nerve roots. The symptoms may also vary depending on the area that is affected by the slippage.
The anterolisthesis causes SEVERE PAIN at the point of vertebrae slippage. That pain may be localized or wide spread. The pain will keep on worsening because of the muscular spasms or guarding as the body attempts to protect itself.
The muscle spasms and guarding will cause them to tighten and this will cause inflammation and severe pains around the tissues that are adjacent to the disc, spine and nerve roots. The pain receptors will thus generate more and severe pain thus creating endless vicious cycle of increasing pain.
The pain may be experienced at one or both legs of the patient. Some patients also complain of weakness of the legs and this may or may not be accompanied by numbness. In anterolisthesis, weakness of the muscles indicates that the condition may cause serious damage of the body nerves and it should be addressed as soon as possible.
Other anterolisthesis symptoms include:
- Inability to control the legs
- Abnormal sensations
- Inability to control the passage of urine or bowel movements
If you had an injury, fall, or you were involved in an accident and you start experiencing the already mentioned symptoms then there is high possibility that you might be suffering from anterolisthesis.
What should you do if you suspect that you have Anterolisthesis?
Anterolisthesis is serious condition that may have debilitating consequences if proper medical intervention is not sought as soon as possible. If you think that you may have developed anterolisthesis you should act quickly.
You can suspect to be having this condition if you experience lumbar spine instability or severe pain of the spine that does not subside after three days. You should immediately consult a neurologist or orthopedic.
The medical specialist will offer you the following treatments depending on the grade of anterolisthesis that you may be suffering from.Grading of Anterolisthesis
How is Anterolisthesis treated?
There are various anterolistheis treatments but they vary depending on the intensity and severity of the condition. The doctor will in most cases need the X-ray image to determine the degree of anterolisthesis. If the X-ray does not give the required detail the doctor may need a Magnetic Resonance Imaging (MRI) or a Computer Tomography (CT) scan.
It is important to note that the patient may not be able to regain the physique and fitness that was there before the event that caused anterolisthesis.
The following are the available Anterolisthesis treatments:-
This refers to the non–invasive medical procedures. Most doctors will want to try the conservative measures if the anterolisthesis does not present very severe symptoms. It’s main advantage is that it is less costly and it actually offers complete recovery if it is professionally offered by qualified medical professional like physiotherapist.
The common conservative treatments for Anterolisthesis include:-
The anterolisthesis patient is put to bed rest. Note that this is not strict bed rest because there is need for some mild exercises of the spine and spinal cord. The patients are advised to avoid engaging in activities or events that may cause further slippage or straining of the vertebrae.
All patients suffering from anterolisthesis are advised to take several days off from work and then spend the following few days or weeks on bed rest that is in most cases coupled with mild exercises for anterolistheis.
The patient may undertake this treatment at home or at the hospital depending on the severity of the condition. If the patient is unable to control the urine and bowel movements as a result of the condition, he or she should seek advice on the diets to take and those to avoid.
This is in most cases accompanied by bed rest. The patient is put on physical therapies by well trained physiotherapists. It will in most cases involve exercises for anterolisthesis so as to improve the movement of the discs and relieve the pain. The physiotherapists will first assess the muscoskeletal dysfunctions before deciding on the best therapy.
The duration of therapy may take several weeks or months depending on the intensity and severity of anterolisthesis. It may involve postural training, heat massage, electronic simulation and various other non-invasive procedures that are aimed at reliving the pain. Back stretchers may also be used in the therapy.
The patient may also be given anti inflammatory medications either orally or through injection to prevent the inflammation. Pain killers are also given orally or through injections so as to alleviate the severe pain that characterizes anterolisthesis.
Note that these conservative treatments are only likely to work in grade I anterolisthesis and in some grade II anterolisthesis cases. If these treatments do not work or they do not produce the worthwhile or expected results, the patient has no option but to undertake surgery.
Like all the other surgeries, this is an invasive procedure that has various risks. In most cases however, the surgery is successful and the patient will get relief. The surgery for treatment of anterolisthesis is referred to as interbody fusion.
How is the interbody fusion surgery carried out?
In interbody fusion, the surgeon will make an incision in the patient’s back. The incision will be done through the mid layers of those ligaments and muscles which are positioned on both sides of the spine. Note that the ligament is the tough tissues that lie between the joints. It attaches the joints, holds them and separates them from each other. The joint is that place in which two bones connect to each other. It allows for bone movement thus causing general body movements like bending and twisting.
After the surgeon has cuts the already mentioned areas, the attachments to the laminae and the spinuos processes will be freed. The laminae refer to the flat and thin parts of the human vertebral arch. The vertebral arch refers to rings of bones that surround the human spinal cord. These rings of bones surround the spinal cord with other vertebral bodies. The spinuos processes refer to the bony parts which project from the vertebrae’s back.
The surgeons use special instrument to remove the small pieces of bones from the lamina such that the nerves are now visible. The nerves will then moved very slightly so that the
Intervertebral discs are clearly exposed. By use of special medical instruments, the surgeon will remove the disc through the left or right side of the patient’s spinal canal. Note that the spinal canal refers to the space that is between bony structure (which surrounds the spinal cord) and the spinal cord.
Once the surgeon has removed the disc, he or she must align the patient’s vertebra. The empty space that remains after the disc has been removed will be filled with a bone. This bone is in most cases taken from any other part of the body of the patient. The surgeon may also use a bone clock (an artificial bone) to fill the space that used to be occupied by the disc that has been removed.
After filling of the space that is in between the vertebrae, the patient’s vertebrae are now fused together. The fusion should be done very carefully to ensure that the bone can never slide or slip forwards again thus causing another incidence of anterolisthesis. To ensure this, the surgeon can stabilize the fused vertebrae by fastening it with screws or other hardware.
Nowadays, surgeons conducting anterolisthesis surgery have entrenched the practice of implanting spinal cage after removing the disc that lies in between the vertebrae that had slipped over the other. The spinal cage is basically a small cage that is threaded and filled with tiny natural bone pieces. The surgeon will cap and implant this packed cage in between the vertebrae.
Permanent stability and fusion will be accomplished when the natural bone will grow through the holes that are in the cage such that it fuses with the tiny natural bone pieces.