Anterolisthesis, Retrolisthesis, and Chiropractic Care

About Listhesis and Spondylolisthesis

Anterolisthesis, retrolisthesis, and chiropractic care are often found to go hand-in-hand, as conservative treatment could prevent many side effects. The origin of the word “spondylolisthesis” derives from spine or “spondylo” and slippage or “listhesis”. Typically, spondylolisthesis occurs “towards the base of (the) spine in the lumbar area”. The lumbar spine is the lower back. Males are more often impacted than females. Those who are active in sports, such as football, weightlifting, and gymnastics might be affected. It is rare for very young children to be diagnosed with spondylolisthesis. The increased activity after age 7, and into the teen and adult years, makes this disorder more common in these older age groups. Developmental spondylolisthesis “may exist at birth or may develop during childhood”, but often it is not noticed until later in life. There is also an acquired spondylolisthesis. Sports and carrying heavy items can wear out or degenerate the spine through repetitive stress. When the connections between vertebrae are weakened, spondylolisthesis may develop. Another way to bring about this condition is via “a single or repeated force being applied to the spine”. Examples of this include “falling off a ladder and landing on your feet” or the impacts football players receive. Many people may not have any symptoms, and only an X-ray may reveal spondylolisthesis. Some of the potential symptoms include lower back pain, swayback (lordosis), weakness or pain in the legs, reduced bladder or bowel functions, or tight hamstrings. Advanced spondylolisthesis symptoms include changes in walking or standing (waddling, for example), making the abdomen protrude and the lower back curve forward. The torso may seem shortened, and the lower back could develop muscle spasms.¹

What are Anterolisthesis and Retrolisthesis?

Anterolisthesis is really a type of spondylolisthesis that refers to the forward slippage of the vertebra. Backward slippage is called retrolisthesis.² The vertebrae of the spine not only protect the spinal cord, but they have spaces for nerves to pass through them so that the rest of the body is connected to the spinal cord. Sometimes, the spine is not properly aligned. Anterolisthesis is graded on a 1-4 scale, from 20% to 100% slippage. Symptoms can range from having trouble with the sensations of temperature and position, to the loss of bladder and bowel control, to poor posture and pain. Anterolisthesis is often due to bone fractures.³ Retrolisthesis is also a type of spondylolisthesis, where the vertebra moves backward. This can happen when the discs that cushion and separate the vertebrae rupture or deteriorate. Symptoms of retrolisthesis include stiffness, numbness, and chronic back pain. Most vertebral slippage concerns the forward movement, but the backward movement of retrolisthesis, while not as common, is still a factor in patients with degenerative diseases, such as arthritis, and for those with severe back injuries. Retrolisthesis is most likely to occur in the cervical vertebrae of the neck.⁴ Anterolisthesis is most often found in the 4th and 5th lumbar vertebrae.⁵

Traditional Treatments

Doctors may take X-rays or use MRI to demonstrate the anterolisthesis. Some of the medical treatments can include interbody fusion. In interbody fusion surgery, doctors remove a disc from between vertebrae and then fuse the vertebrae together. The fusion occurs with pedicle screws and bone grafting. In TLIF, or transforaminal lumbar interbody fusion, “the disc is removed from the side”, and in PLIF, or posterior lumbar interbody fusion, “the disc is removed from the back”. With TLIF, the middle layer of ligament and muscle “that sits on either side of the spine” is cut, removing the lamina and exposing the nerves. The disc is removed from either or both sides of the spinal canal, clearing the space between the vertebrae. Then it is “packed with a bone graft and either a bone block or cage implant”. Pedicle screws are often used to keep the fusion secure. Sometimes additional bone graft will be needed as well, to “ensure a solid fusion”.⁶ Pain medications and physical therapy may be some medical treatments recommended for retrolisthesis. Retrolisthesis generally affects the cervical region of the body. The cervical bones, in the neck, are smaller and more prone to injury and slippages than the lower and middle spine sections. Patients might experience “chronic dull neck pain and tenderness”. Lower back slippages decrease mobility, causing pain and stiffness when standing, walking, or sitting. Tingling or numbness in the legs, torso, or arms is also possible. Degenerative disorders, without treatment, worsen over time. Medications can manage pain and swelling, and rest is also useful.⁷ Conservative treatments for anterolisthesis could include rest and physical therapy, but some doctors proceed immediately with surgery. Surgery carries the risks of nerve damage or infection.⁸

Chiropractic Evaluation

Before taking medications or having surgery, patients with spondylolisthesis can seek chiropractic care. Chiropractors are musculoskeletal experts, and they can diagnose spondylolisthesis by evaluating the spine as a whole. Even if only one part of the spine hurts, more of the spine may be impacted. Spondylolisthesis may not even be the reason for the back pain. In a chiropractic evaluation, the DC will take a medical history and possibly an X-ray; however, X-rays are not always needed “except in a patient who is unresponsive to conservative management”. Next, the chiropractor will find out which areas have disc injury, restricted motion in the joints, ligament injury, or muscle spasms. Static and motion palpation techniques, or examination by touch, are used. Chiropractors can feel for tenderness and tightness, as well as range of motion. They will typically examine the patient’s gait, alignment, and posture. Depending on the “stability of the spondylolisthesis…it may be necessary to order special imaging tests” (bone scan, MRI). In some cases, a patient will be referred to a spinal surgeon.⁹

Chiropractic Care for Spondylolisthesis

Chiropractic care has the goals of improving posture, spinal mechanics, and function. For spondylolisthesis, chiropractors do not actually “reduce the slippage”, rather, they “address the spinal joints above and below the slipped vertebrae”. As a result, they can improve motion and alleviate back pain.¹⁰ Rest and activity restriction can be part of the early treatment. Patients could be taught corrective exercises for their posture issues that resulted from spondylolisthesis. Exercise will help patients support their back better, especially for lumbar (lower back) muscles. Patients can work on their general fitness, and they may use “heavy-duty elastic tubing (for) isotonic resistance exercises”. Some patients might benefit from orthotics, especially if they have low arches or flat feet. It is important to strengthen the spine and improve stability. “Spinal stabilization exercises” include abdominal bracing, lower abdominal hollowing, and posterior pelvic tilt. Particular chiropractic manipulations that may help spondylolisthesis include side-posture manipulations, adjustments below or above the misaligned segment, flexion-distraction, and sacroiliac (SI) joint adjustments.¹¹ Spinal manipulation identifies restricted joints and a gentle thrust is used to return proper motion by stretching soft tissues. Manipulations are hands-on methods of treatment. In flexion-distraction, this non-thrusting technique utilizes a special table with a “slow pumping action”. Other chiropractic treatment options for spondylolisthesis include electrical stimulation, ultrasound, manual resistance techniques and joint stretching, trigger point therapy, and instrument-assisted soft tissue therapy and manipulation. Chiropractors apply pressure with their fingers, on certain points, in order to reduce tension, during trigger point therapy. Instrument-assisted manipulation, also non-thrusting, uses a hand-held instrument to apply force. Chiropractic treatments emphasize that prevention is important, as patients return to their regular activitites.¹²