Recently the North American Spine Society updated their guidelines (suggestions to doctors on how to understand, diagnose and treat medical problems) for degenerative lumbar spodylolisthesis. Spondylolisthesis is a fancy way of saying 'slipped vertebra' (but is not the same as 'slipped disk', mind you). They arrived at their conclusions by assembling a team of reviewers to read the latest research in this area. The great thing about guidelines such as this one is that the suggestions found within are based entirely upon the results from medical research; in other words, the reviewers have located evidence that the treatments, etc. they suggest really do work, along with the degree to which they work, based on the quality of the studies they consult. The guidelines are current up to June 2007.
The reviewers were looking for answers to specific questions that will help health care providers with key issues. They were interested in things like how degenerative lumbar spondylolisthesis shows up (for example, which symptoms might be clustered together, and why) when and what type of surgery might be useful, what makes the slippage progress and what doesn't, and when conservative care would be all the treatment you would need.
Here are a few of their findings:
Lumbar degenerative spondylolisthesis is the slipping forward of a low back vertebra (over the one below it). Symptoms vary and it's possible to have spondylolisthesis without experiencing any back pain, leg pain or other associated problem at all. If you do not have neurological symptoms such as muscle weakness or cauda equina syndrome, it is quite possible conservative care may be all you need for your well-being. If you do have neurological symptoms, you may find that you will need surgery to prevent a decline in your ability to function in your everyday activities.
The reviewers also found that once the intervertebral disk has lost more than 80% of its original height, the forward slipping doesn't happen as much. They think that perhaps the presence of bone spurs, hardened ligaments and similar spinal changes provide some stabilization to the area.
Spondylolisthesis is what they call an anatomical finding. According to the guidelines, the best way to locate it is with an X-ray taken from the side. But sometimes spinal stenosis comes with spondylolisthesis, and in this case MRIs, myelographs or CT myleographs will help the doctor to better visualize the problem.
If you would like to read the guidlines in depth, you can download the report at the NASS website.