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
Source: orthoinfo.aaos.org
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.
Spinal column and its different regions
Source: http://0.tqn.com/y/pilates/1/5/A/A/-/-/ADAMspine.jpg
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:
- Tingling
- 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
Source: www.spineuniverse.com
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:-
Conservative 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:-
Rest:
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.
Physical Therapies
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.
I am a retired LAPD officer, with an industrial injury to psyche fully accepted as per Work Comp award and a Writ of Mandate to the Pension Board. Date of injury was established as 10-1-72..
I am a retired LAPD officer since 10-1-72. The Work Comp award and the Pension Board granted me a 50%, injured on duty type pension, and life time medical for injury to psyche.
However, recent MRIs, xrays, and opinions of neurologists, neurosurgeons, psychiatrists and psychotherapists agree, that there is an anterior listesis,C-3 C-4 and total lack of cervical discs from C-4 to C-8,probably caused by the choke hold practiced since I enter the Academy, which was not detected, nor treated in any way by the City of Los Angeles in the 70s.
The pain, tingling sensation,difficulty walking, urinary incontinence and other symptoms are getting worse with time. Living in Costa Rica, all experts concurr that the cervical lesion C-4 C-8 is untreatable,the AL C-3 C4 is too risky. The entire cervical lesion is, according to these doctors, and a California Neurologist degenerative in nature. Yet Tristar Risk Management, third party administrator for the City of LA, the WCAB of LA,and others refused to do anything about it….I do not want anything more than spend my last days out of a wheel chair.
I simply refuse to believe that there is no treatment, that in five years or so (ball park time given unofficially by experts)I will be confined to a wheel chair, in pain, or dead.
Just, to respecfully let every government or public employee know: ” once City Hall has used us….if we want or need help for undetected industrial injuries….our only hope are the services of an a law firm….not doctors….
Eduardo R Jimenez
former LAPD
17649
My 11 year old granddaughter has been diagnosed with grade 4. What can we expect? MDs want to do surgery.
Thank you for the valuable information about ANTEROLISTHESIS. I was walking along a cement curb/wall the suddenly fell about 8 inches so that I stepped off into thin air, fell hard landing on the concrete with the base of my spine ‘tailbone’. I was carrying a heavy backpack as well. I have just had 4 cervical vertebrae fused and I continue to have muscle pain just to the right of my ‘tail-bone’ area and I suspect that the hard fall on concrete is possibly why I am struggling as described.
Wayne S
North Vancouver, BC
Anterolisthesis is a very painful condition although learning about treatments and option has helped to understand the disease.
This site was very helpful in learning the meaning of and the treatment options of Anterolisthesis.
I had a posterior/ anterior 360 of the L5 S1 Dec 27, 2013. Have had a lot of pain and numbness, loss of bladder and bowel and a lot of other trouble. Had an MRI with and w/o contrast a week ago the MRI findings show that I have endplate degenerative disease and mild anterolisthesis at the L5 S1. I don’t know what to do.
I thought this whole article was very informative and very educational for anyone looking for this type of information.
Cant Find a surgeon that can complete this surgery in the 61938 area…
I’m scared and please I just got diagnosed with anterolisthesis 1-2mm L1/-15 , I’m going in for a MRI lumbar I’m scared !
Is grade 1 of C4 on C5 and C5 on C6 something to be worry about or be wary of? Will my condition worsen as I age? I am 66 and I was having my 2nd yarly test for monoclonal gammopathy. My doctor didn’t mention anything to me about the anterolisthesis as he was an oncologist. “Degenerative changes of facet arthropathy, mild disc space narrowing, and disc degenerative disease, most noticeable at C3-5 and C5-6. Verterbral body heights are maintained.” The latter was some additional information and the remainder of the bone survey report seemed normal.
Thank you for the information. I am so glad to know this as I did have a serious fall.
Hi I have had severe pain throughout my lower back and legs for about 6 months now. I finally broke down and went to my doctor. They ordered a ct myelogram done due to the t.l.I.f. fusion done on my spine already. Just this Monday my doctor sent me the results back stating I have grade 2 anterolisthesis on L5-S1 (same area I had fusion). My doctor has given me nothing to help with pain. She hasn’t even wrote me out of work or told me anything about this. What should I do?
Apparently my severe pain has been caused by this slipping that is bone on bone per the doctor who has immediately referred me to a neurosurgeon and for MRI of my C spine as C4-5 are affected. If this is fused what kind of movement will I have? will I be able to drive? Go bowling or 4 wheeling? I rolled s four wheeler down a mountain it did a “scorpion” thing they called it I and it knocked me unconscious breaking my sacrum as it landed on top of me with full force sandwiching me between the force of the four wheeler and the deep crevices of the rocks.
I was told by the back doctor I am seeing specific exercise is required. Inter spinal gel is not even between discs, 70 % to the outer side of my spine. I was encouraged exercise to try to even the gel between discs. I am to lie on the floor on my stomach, elevate on my elbows, which arches my back and will encourage the gel forward. With his help we are looking at 2 months.
Comments
I have been in so much pain with this for the past 3 weeks. I wish the doctor had advised me 12 months ago when it was first diagnosed the importance of the exercise etc. I also wish the condition had been better described back then.
This article has been an enormous help in describing my condition and giving me hope. It has been very frightening. I have never experienced pain this intense before. I now have a better understanding. It describes my pain to a ‘t’
After 10ys I fianally got diagnosed with C1 instabilty and a few hernatiated disc in my cervical spine. I have been unable to work and function. I found Dr. Franck in Florida who is an expert on pinning C1 and C2. Important to have an upright MRI and DMX scan. They have definate. In the meantimw Block Therapy and Fluid Isometrics treatments have been keeping me alive, otherwise I would have been in a wheelchair already. Hope this helps someone.
The article was excellent. I just received a copy of XR Lumbar Spine Minimum 4 views to take to my appointment with an orthopaedic doctor. I have been in severe pain for 5 weeks now and also in physical theraphy, which has not worked so far. The findings of my X-ray are a grade 1 anterolisthesis of L4 and L5 vertebral body. Mild to moderate degenerative disc disease is noted. There is gentle levoscoliosis. I am afraid to have surgery but can’t continue with this severe pain for the rest of my life. I am 72 years old.
Surgery on my C-spine C5-7 in 2009. Once you have any spinal surgery, especially more than one disc your life changes forever. You have to be extremely careful and am very limited with all activities and gave up my past life of activities to preserve what I have left and STILL a constant nightmare. I have Cervical, Thoracic and Lumbar injuries with the neurological to scare the crap out of you for sure! I have neck injuries since my surgery and the bad ones don’t tell you that once you have surgery your risk of more injury is greater! I know have instability of my C7 disc related to surgery and went through hell the last 3 months. My Neurosurgeon in NYC ordered a C-spine MRI flexion/extension and showed grade 1 Anterolisthesis that I have never heard of until now. However, I have good reasons to not trust the radiologists except my symptoms match the report. Been through 8 years of hell on that one. I have my one specialist in NYC who knows WTH he is doing . Next stop, then I may have some idea what is going on!
I am praying for us all. this is chronic pain at its worst. my l-5 s-1 are at a 2 degree. i am only 57 & want my life back. i pray we all find the best doctors & nurses to help us all. AMEN!
Hello my name is Gina . My femurs broke in 2008 I was 46 years old now I am 55 and a Ct showed L1-L5 bilateral pars defect . I was complaining for 3 yrs about pain when I would stop on a dime . It felt like when I was a teenager hopping of the hood of the car , I would get a radiant pain right threw my femurs . Bone biopsys , bone scan and 3 bone density test all come back normal . I also experience stomach bloating and painful pressure . Something is defenatly wrong with me . I just can’t seem to get a diagnoses . I don’t understand why my bones are cracking and breaking .
Age 22 L5S1 fusion. Grade 4 spondylolisthesis
Age 27 Removal of broken screws at l5-s1
Age 30 C5-c6 fusion
Age 32 . Total right hip replacement (septic, osteomyolitis)
Age 42 hardware removal at c5-6 and c6-t1 fusion. Soinal cord being crushed from a mva whipladsh that broke the back side of neck .
Just had mri on lumbar …. Pretty much screwed. Bulging nucleous’ now at l2-5. . .. At age 22 i was told wheelchair by 50. Just turned 43 on 21st of November, and want nothing more than to die . there’s no getting your life back…wish i had only a few months of pain…. I have been in pain , chronic , severe since the age of 14.! Sorry to be such a downer but SUCK IT UP PEOPLE !!! Enjoy life while you still can. Do whatever you want that makes you happy! Oh and find someone to love you , cuz theres only 1 thing that sucks more than the pain you will feel over the years ….and thats going thru it all alone… And without opiotes…
Best wishes to you all, I feel your pain and am so incredibly sorry for it. I wouldn’t wish any part of what ive endured on my worse enemy…
Hi, my father suffer from accident and having grade I retrolisthesis of C4 C5. He is suffer from severe pain,there is also fracture of spinous fracture. We don’t have any proper facility in our area in India. My father died in hospital.
Hello,
I had a minor skateboarding accident roughly a decade ago, I was long-boarding and accidentally hit a car straight on with my head tilted slightly forward, fortunately I hit the center of the car door so it was a relatively soft hit. Now, years after I suspect that injury is responsible for my minimal anterolisthesis at C3-C4, C4-C5, C5-C6 measuring up to 2mm each. Doctors think it’s in-determinant and possibly congenital. They also mention no significant bony foraminal narrowing seen on oblique views, no abnormal disk space narrowing.
Can you predict further misalignment, and good treatments to prevent worsening? I’m only 27 and I hope this doesn’t get too much worse over time.
Had an Xray the other day and found out that I have 3.5mm anterolisthesis of c3 on c4 and milder on c4 and c5. Moderate facet arthropathy, multilevel osteophyte formation, disc space narrowing at c5 and c6, and of course degenerative disc disease. I’m 50 and worried. I’ve been in pain for years and I just had my MRI today. Should find out the results soon =(