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.
lumbar Interbody Fusion
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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