An Overview of Spinal Degenerative Spondylolisthesis and How It Causes Back Pain

In the world of spinal arthritis and spinal degeneration, one of the
most common problems seen with aging is degenerative
spondylolisthesis. The "spondy" part refers to the spine, and
"listhesis" refers to slippage. As a person's ages and the spine
experiences arthritis, there is a cascade of degeneration that occurs
in the following steps. The steps are not singular events, there is
considerable overlap in occurrence.Degenerative Disc Disease
Facet Joint Arthritis
Facet Joint Instability
Intervertebral segment instability
Slippage of one vertebrae on anotherAs the spinal disc degenerates,
the facet joints of the spine see increased and abnormal stresses from
what is typically seen. This creates facet joint arthritis by the bony
elements of the joint doing what they do best - grow bone. Optimally
they would grow more cartilage, creating joint lubrication and
preventing arthritis. But the human body loses its ability to keep up
with necessary cartilage growth as we age, so it turns to growing bone
because it's always good at that.The bony overgrowth in the facet
joint is something that is not needed or desirable and creates
instability in the spinal segment. This leads to slippage of one
vertebrae on another. The slip is categorized by the percent slip of
the vertebral body on the one below. If it's less than 25% it's a
Grade 1 slip. If it's 25-50%, it's a Grade 2. If it's 50-75%, it's a
Grade 3. And 75-100% is a Grade 4. By and large for the degenerative
kind of spondylolisthesis, the slips are Grade 1 or Grade 2.As a
result of the slippage, patients may begin to have an increasing
amount of back pain. This can be from the arthritis in the facet
joints, the mechanical instability experienced, the degenerative disc
disease, or a combination of all three.Another consequence of the
slippage with degenerative spondylolisthesis is that the spinal canal
may see a decrease in cross sectional area, leading to spinal stenosis
with resultant leg pain, sciatica, and buttock and hip pain.