Anterolisthesis

What is Anterolisthesis?

Anterolisthesis is a condition whereby the upper vertebra in the spine slips over the lower vertebra forwards, moving out of its original position. When this happens, it causes pressure on the spinal cord and other spinal nerves, causing pain and other symptoms. ^[1]

How Anterolisthesis develops?

To understand how an individual may develop anterolisthesis, it is important first to explain the anatomy of the spine, where the condition develops. The main players are the vertebrae, which are stacked along your back to form the spine. They are hollow at the center to provide room for the spinal cord through the spinal canal, which comprises of all the nerves of the body. In terms of structure, the vertebrae are wider at the top and bottom while narrower around the middle to enhance stability when they are stacked on top of each other. ^[2]

Anterolisthesis

Despite this need to remain stable, these vertebrae still move on top of each other due to the layer of cartilage between each two vertebrae. These slight movements allow you to bend and twist effectively. However, sometimes, one vertebra can slip too far from its limits, either backward or forward. When the upper vertebrae slips forward, this condition is what is referred to as anterolisthesis. On the other hand, backward slippage is referred to as retrolisthesis.

In this awkward position, the spinal canal becomes narrowed and depending on the amount of slippage, it can cause moderate to severe compression of the spinal cord. It’s not just the spinal cord that’s affected, though, since exiting nerves branch out from in between the vertebrae to various parts of the body. These nerves, too, can become compressed due to the unusual positioning and lead to symptoms beyond the back.

Symptoms

The first sign is usually pain, caused by the compression of the spinal nerves. Depending on the location of the slip, the pain could be around the lower back, the center back and even the neck. If the slippage compresses a nerve, there will be certain pain in the area that this nerve innervates. For example, nerves that provide sensation to the hands can cause pain in the shoulders and radiate through the arms to the hands. ^[3]

For nerves that serve the abdomen, it may affect an individual’s bowel and bladder control. Nerves also provide signals for motion, so there may also be signs of difficulty moving the arms, legs, and back.

Causes

Anterolisthesis is most common among the elderly, because aging is one of the main causes of the condition, with age, the cartilage between vertebrae becomes thinner and the vertebrae can slip out of position. The other common cause is trauma to the back, which can directly cause the slippage or cause a fracture which leads to the slippage. Other causes include: ^[4]

• Genetics – birth defects in the development of the spine can cause anterolisthesis even in children
• Arthritis – a common disease of the joints, which can also affect the spine
• Overuse – individuals who perform physically strenuous activities like weight-lifters can also develop the problem
• Tumours in the spine – a tumor can exert pressure on one vertebra, causing it to slip out of position.

Diagnosis

The first step in the diagnosis involves a study of the symptoms experienced by the individual, but there are many conditions that can lead to similar symptoms. The diagnosis will also involve a physical examination, where the doctor tries to locate the source of the problem and check for any other visible causes. ^[5]

If the doctor believes the symptoms may be indicative of anterolisthesis, imaging technology will be used to take a look at the structure of your spine. The most commonly used technology is X-ray, which is very effective for bone defects, and it provides a picture of the vertebrae. Further images provided by magnetic resonance imaging (MRI) and CT scans will inform the doctor about the level of nerve damage based on the extent of slippage.

Your doctor will then grade the severity of the anterolisthesis depending on the extent of the slippage from a range of 1 to 4:

• grade 1 – slippage of less than 25%, mild slippage
• grade 2 – slippage of more than 25% to 49%
• grade 3 – slippage of 50% to 74%
• grade 4 – slippage of 75% and above

Anterolisthesis Grades

In rare cases, there have also been situations where the slippage was 100%, meaning that the top vertebrae had slipped completely off the bottom one.

Treatment

The treatment recommended will be based on your grade of slippage. Since the spinal cord is pretty flexible, most individuals suffering from grades 1 and 2 of anterolisthesis won’t experience any major symptoms, and only conservative treatment options are made available. Some of these are: ^[6]

Rest

In the mildest cases, the slippage of the vertebrae can be reversed simply by resting and avoiding any physically strenuous activity. This is especially helpful if the condition is experienced by a young individual whose body can still heal on its own, quickly. To help the process along, you may be advised to wear a back brace for added support and to use orthopedic pillows while sleeping to support the spine.

Pain relief

If you’re suffering from pain, some pain relievers can also be prescribed. Again, the type of medication will depend on the severity of the symptoms, whereby mild symptoms receive mild pain relievers and severe symptoms receive the strongest pain relievers. Most of the mild painkillers are non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin and steroids to treat any inflammation. Severe symptoms may need opioids, which are narcotics, but very effective.

Most often, the NSAIDs are prescribed as the first line of treatment, but if the symptoms persist, then opioids are given. It’s important to do this because opioids tend to create addiction, which may leave you with more problems after you’re treated.

Physical therapy and chiropractic treatment

Both of these measures are palliative and do not address the vertebra directly. Physical therapy helps to reduce the pain experienced by promoting the release of endorphins and at the same time strengthening the back muscles so they can increase support to the spine. Chiropractors attempt to manipulate the vertebrae back into position through massage, and it often works.

Surgery

This is reserved for the most severe cases where the individual experiences debilitating symptoms. The surgery may either be to reduce nerve compression by realigning the vertebrae, or stabilizing the spine using internal fixation. The latter procedure involves using metal rods, screws, plates or wires to keep the spine in position.

References:

1. Anterolisthesis Available from: http://www.spine-health.com/glossary/anterolisthesis
2. Development of anterolisthesis Available from: http://healthfixit.com/anterolisthesis/
3. Symptoms of arterolisthesis Available from: http://healthsaline.com/what-is-anterolisthesis-grading-1234-treatment.html
4. Causes of anterolisthesis Available from: http://www.medicinenet.com/spondylolisthesis/page2.htm
5. Diagnosis of anterolisthesis Available from: http://www.medicinenet.com/spondylolisthesis/page3.htm
6. Treatment of aneterolisthesis Available from: http://www.hxbenefit.com/anterolisthesis-symptoms-causes-and-treatment.html