Lumbar Spondylolisthesis

What you need to know

A phenomenon whereby the facet (joint) capsule of the spine weakens together with the degeneration of the disc which acts as a cushion between the bones. The disc collapses, and loses its structural stability. As a result, the two bones slip and slide on top of one another (instability) and the ligaments and tissues within the spinal canal begin to thicken and narrow the spinal canal. The slippage of one vertebra on top of another vertebra is called a spondylolisthesis. Other causes can include stress fractures, trauma and congenital abnormalities.

Most patients will develop progressive back and leg pain that is typically worsened by walking. In severe cases they will experience numbness and weakness in their legs. They may even walk with a shuffling gait. The two most common regions where this develops is L3-4 and L4-5, with L4-5 the most common. It is two to three times more common in females and people between the ages of 50-65 are predisposed.

Motion x-rays whereby a patient flexes and extends their lower back can demonstrate the slippage and unstable motion of the vertebrae involved. A MRI and CT scan is also used to assess the severity of the spinal canal narrowing. A nonoperative intervention is initially pursued except if a patient presents with neurological weakness, with the use of non-steroidals, nerve inflammatory pills, occasionally narcotics and physical therapy to condition the back muscles to reduce the symptoms. If the symptoms persist then a surgical solution can be performed.

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lumbar Interbody Fusion

During a lumbar interbody fusion, the two vertebrae are fused together to provide stability which is usually performed by placing screws and rods to the vertebra which act as a bracket to stop the abnormal motion. Cages can also be inserted between the bones to replace the bad disc which helps both with stability and creating a successful fusion. The fusion can be performed minimally invasively either by going through the patients side (LLIF – Lateral Lumbar Interbody Fusion), or by going through the back (TLIF – Transforaminal Lumbar Interbody Fusion).
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Laminectomy

To alleviate the pressure on the nerves which is usually the cause of most of the debilitating symptoms, a laminectomy (decompression) can also be performed. During this procedure, bone spurs and thickened ligaments are removed to create more space for the spinal nerves.

Patrick J. Horan, MD, MBA, FACS

Patrick J. Horan is an orthopaedic surgeon and sports medicine specialist with two decades of experience. He is board-certified in orthopaedic surgery and sports medicine. After receiving his undergraduate degree from Duke University in Durham, N.C., Dr. Horan earned his medical degree from Tufts University School of Medicine in Boston. Residency and Internship were both completed at Walter Reed Army Medical Center in Washington, D.C. He also received an MBA from Auburn University in Auburn, Ala.

Dr. Horan served 10 years on active duty in the US Army as an orthopaedic surgeon before entering into private practice. Dr. Horan is the founder of the Westchase Orthopaedic and Rehabilitation and the official surgeon of the Tampa Bay Rowdies. He maintains professional memberships with the American Academy of Orthopaedic Surgeons, the American Academy of Orthopaedic Sports Medicine and the Arthroscopy Association of North America.

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Dr. Patrick Horan and the other orthopedic surgeons and specialists at Westchase Orthopedics & Rehabilitation have served hundreds of patients in the Tampa Bay area. Our patients choose us because we are able to offer them viable solutions to their pain. We offer hope to patients who have been athletes for years and suddenly find themselves faced with the possibility of never playing again, to elderly patients who want to maintain their independence and do things like drive and grocery shop alone, to parents who aren’t sure what is wrong with their children’s knees or elbows and want answers. Unlike in many other practices, you are not treated like just a number; we take the time to listen to your concerns and symptoms, accurately diagnose the source of the problem, and walk you through what will happen during the course of treatment. Get in touch with our office today to schedule an appointment!

Testimonials

Dr Horan has done a few of my knee surgeries and has always been the best surgeon. Dr Lao has been my physical therapist for every knee surgery and his results are proven and outstanding. I’d be in bad shape if it wasn’t for dr Lao and his staff who go above and beyond to do what’s needed.

Testimonials

Dr. Lao is simply the best! His intense educational training and specialty of the spine are something that you seldom come across these days. When I lived in Bradenton for 9 months I would drive over an hour just to see him because he was the only one I trusted with my physical issues. His assistant Sam is wonderful and Lisa at the front desk is always very helpful! There is another PT there that I have not treated with, but I only hear great things about him! 🙂 I will not go anywhere else.

Testimonials

This review encompasses both Dr Horan's orthopaedic side of the business & Dr Lao's physical therapy side. I have no idea if their practices are actually related, but there's only one street sign & only one Yelp check-in. Luckily, I think both doctors are excellent.

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