What is Listhesis?
There are many listhesis treatment options for the various associated conditions. Listhesis conditions include spondylolisthesis, anterolisthesis, retrolisthesis, and lateral listhesis. Joint instability, or “loss of spinal tissue integrity in the muscles, tendons, and…ligaments”, can be referred to by these types of listhesis terms.
The conditions are named based on the direction that the vertebra slips. If the lumbar (lower back) or cervical (neck) vertebrae have an “anterior vertebral slip” (forward), that is type of spondylolisthesis called anterolisthesis. One type, isthmic spondylolisthesis, is often associated with trauma (isolated or repeated), such as “repeated lumbar hyperextension, as with gymnasts”. Another type, degenerative spondylolisthesis, has to do with an “upper vertebra sliding forward” due to “long-standing anterior subluxation”. Spondylolisthesis is measured on a scale of 0 (no slip) to IV (complete slip). This condition can also be congenital, but it is frequently aggravated by isolated trauma due to a fall, repeated trauma from certain sports, or arthritis.
Lateral listhesis refers to a vertebra that “slides off another vertebra in…the coronal and axial planes”.1 If the displacement is backward, it is type of spondylolisthesis called retrolisthesis.2
Spondylolisthesis, Anterolisthesis, and Retrolisthesis
As noted before, a condition in which a vertebra (bone in the back) slides forward over the vertebra below it is called spondylolisthesis. Generally, it affects the lumbar spine, or lower back. This can lead to the nerve roots or spinal cord being compressed, causing symptoms such as weakness, numbness, or pain in one or both of the legs. It is rare to lose bladder and bowel control, but if this does occur, it is very serious and requires immediate medical attention.
Spondylolisthesis can be congenital (since birth), due to a trauma or accident, from a stress fracture and overuse, or because of arthritis or an infection. Teens and children in sports are affected by spondylolisthesis. In particular, weight lifting and gymnastics cause overuse injuries and stress fractures in the back bones. Older adults could also be impacted as “wear and tear on the back leads to stress fractures”. Sometimes just the joints and disc are “worn down and slip out of place”. Though all three of these causes are not uncommon, treatment should still be sought and prevention should be practiced in order to avoid or reduce the severity of this condition.3
Retrolisthesis, simply put, refers to the “backward slippage” of an upper vertebra on a lower one. Forward slippage is also known as anterolisthesis. Spondylolisthesis is the slippage “forward or backward”. Spondylolisthesis could lead to spine deformity and central spinal stenosis (the spinal canal narrows) or foraminal stenosis (exiting nerve roots are compressed). Even though the lumbar spine is most often affected by spondylolisthesis, the thoracic spine (mid and upper back) and cervical region (neck) can also have this kind of damage.4
Lateral Listhesis and Scoliosis
One type of spondylolisthesis, lateral listhesis, refers to movement of the vertebral to the side, instead of forward or back. This lateral instability is not uncommon in people with scoliosis as the “lateral listhesis is not uncommon adjacent to the epicenter of the curve”.5
Scoliosis is a spinal misalignment. Scoliosis actually refers to the “overall curvature of the spine” of “at least 10 degrees”. Listhesis refers to just “the alignment of two adjacent vertebral bodies” of the spine. Whenever there is a misalignment in the spine, the bones can end up bearing “asymmetric loads”, leading to spinal degeneration.6 Lateral listhesis could have a displacement to the right or the left. Scoliosis, the “abnormal curvature of the spine” can be a result of structural causes, but most of the time it is unknown, or idiopathic.
Sometimes congenital issues cause scoliosis, but this condition may also “be due to spinal degeneration”. The curve may be to the right or left (mediolateral direction) or it can be forward or back (anteroposterior direction). If it is a “posterior convexity”, that curvature is referred to as kyphosis. If the curve is “posterior concavity”, it is called lordosis.7
Symptoms and Listhesis Treatment
Some of the symptoms of spondylolisthesis include a stiffening back, tightened hamstrings, changes in posture (such as leaning forward), waddling or other change in gait, and lower back and leg pain. Numbness and tingling may also occur, and standing, sitting, sneezing, and coughing might be painful. Treatment options can range from anti-inflammatory medications and steroids to physiotherapy or even surgery. Of course, surgery should be considered a final option and only pursued if the patient really needs urgent and invasive medical attention.8
In the most serious conditions, patients may lose bladder or bowel control. Generally, many patients may have difficulty walking, buttock and back pain, and weakness and numbness in the legs. Weight loss and physical therapy, core strengthening, and medications for pain may all be prescribed by a medical doctor before surgery is recommended.9
Sometimes spondylolisthesis is referred to as a slipped disc, and some patients may not have any symptoms. Others may develop swayback (lordosis) or roundback (kyphosis). The most common sports that cause this condition in children are gymnastics, weightlifting, and football. In adults, wear and tear (spinal degeneration) is the most likely cause of spondylolisthesis.
Often, the first line of treatment options include conservative care such as modifying activities, stopping sports, stretching, using a back brace, anti-inflammatory medication, and physiotherapy.10 Using a stationary bike, hydrotherapy, exercises, stretches, and chiropractic manipulation can also help patients reduce pain and improve motion and flexibility.11
Chiropractic Treatment for Spondylolisthesis
Chiropractic treatment is non-surgical and natural. Spondylolisthesis may not be the cause of back pain, but if the patient has “mechanical back pain”, chiropractors are experts in treating these types of conditions. The entire spine needs evaluation because other regions may be impacted, even though only one area might hurt. The chiropractor can feel for movement restrictions and examine posture and gait of the patient.
Some of the techniques used may be spinal manipulation (either by hand or instrument-assisted) and flexion-distraction, a method that uses a table with a pumping action. Other manual therapy options include trigger point therapy and manual joint stretching and resistance techniques. While the chiropractor “can’t reduce the grade of spondylolisthesis”, they can “address any underlying mechanical or neurological causes” of the symptoms.12
Massage Therapy and Spondylolisthesis
Patients may not be able to continue with gymnastics, weightlifting, diving, rowing, swimming (butterfly), tennis, wrestling, or football. Females are more likely to develop spondylolisthesis than males. Other groups affected by this condition are “loggers and soldiers carrying heavy backpacks”. The reason that adolescents could develop spondylolisthesis is that their “bones are not fully formed”.
The most common symptom is lower back pain, which “increases with lumbar extension”. Flexion moves the vertebra back into the normal position, so it decreases the pain; however, “hip flexion with the knee in extension generally is limited due to hamstring tightness”. Patients will often have soft tissue tenderness in the lower back and sacral region, and palpation might produce pain due to anterior pressure. This anterior pressure may “push the vertebra further into…slippage”.
After consulting with a primary care professional, massage can help “in reducing overall muscular hypertonicity associated with spondylolisthesis”. It is important for the massage therapist to assess the situation by working with other healthcare professionals to make sure appropriate treatments are performed. For example, decreasing the tightness of the hamstrings could work against what the patient needs because the tightness may be reducing the forward slippage of the vertebra. In addition, “forward slippage of the vertebra has to be confirmed by X-ray and is not testable with physical examination alone”.13
Learn more about spondylosis and spondylolisthesis.