Anterolisthesis is the abnormal alignment of the bones in the spinal cord that is usually caused in the lower back. When the vertebrae are misaligned, it can pinch the nerves which can lead to very painful consequences. Get More about anterolisthesis has been discussed in this article.
What is Anterolisthesis?
Anterolisthesis is a certain type of Spondylolisthesis where the affected vertebra slips forward on the vertebra below it. Similarly, if the vertebra slips backward, the Spondylolisthesis is known as retrolisthesis. This condition is most common in the lumbar or lower portion of the spinal cord. The slipping of vertebrae is usually caused by the frequent wear to the spine, genetics, trauma to the spine or age.
Anterolisthesis is graded on a scale of 1 to 5 which indicates the severity of the slippage with an increase in every grade. Grade one indicates less than 25% slippage whereas grade 5 indicates the most severe stage where the vertebrae have completely slipped out of its place.
Anterolisthesis Vs. Spondylolisthesis
Anterolisthesis is one type of Spondylolisthesis when the vertebrae displacement is forward or anterior. It can be categorized by location- which vertebra is affected and which parts of it are affected. It is also categorized by cause- trauma to the spine, genetics, infection, surgery, age, etc. To check the degree of slippage, it is graded. It usually involves the fifth lumbar vertebra and can cause symptoms like:
- Stiff back and tightened hamstrings that result in changes of the posture and gait.
- A semi-kyphotic or forward-leaning posture is noticed that is caused by compensatory changes.
- Noticeable atrophy in the gluteal muscles is seen because of the lack of use.
- Lower-back pain with shooting pain from the buttocks and the posterior thigh or lower leg through the sciatic nerve is experienced.
- Numbness and tingling sensation.
- Difficulty in sitting or standing up.
Spondylolisthesis is the displacement or slippage of the vertebra from its original place. It is defined by medical experts as the displacement of the vertebra in any direction and there are different types of Spondylolisthesis like anterolisthesis and retrolisthesis. In practice, it is often used synonymously with anterolisthesis. To describe Spondylolisthesis both its types must be stated:
Anterolisthesis: The symptoms and causes of anterolisthesis are mentioned above.
Retrolisthesis: Retrolisthesis refers to the displacement or backward slip of the vertebra in the spinal cord. This type of Spondylolisthesis can be easily detected on a lateral X-ray of the spine. This type is found most commonly in the cervical spine or lumbar region but is also found in the thoracic area of the spine.
What Causes Anterolisthesis?
Anterolisthesis is mainly caused by the impact on the spinal cord which is the displacement of the vertebra from its position. Anterolisthesis can be caused by bullet wounds, an impact from vehicle collisions, spinal cord injuries, falls from heights, age, genetics and more. In severe cases, fracture of bones which are adjacent to the spinal cord can also cause anterolisthesis. It can also be caused by poor posture, core weakness, or instability. These conditions will lead to degenerative anterolisthesis or gradual breakdown of the segment. The most common causes are explained in details below:
- Trauma to the Spine: This results from acute fractures that can take place in the neural arch.
- Degenerative Anterolisthesis: This generally develops in older people that can develop from joint remodeling and facet arthritis. Ligamentum Flavum weakness and joint arthritis can lead to the slipping of a vertebra. This type of anterolisthesis is more commonly seen in women and people older than fifty years.
- Dysplastic Anterolisthesis: This is caused as a result of congenital abnormalities in the upper sacral facets or the inferior facets in the fifth lumbar vertebra. This type of anterolisthesis accounts for 14 to 21% of all the anterolisthesis cases.
- Isthmic Anterolisthesis: it is caused by a defect in the pars interarticularis and can also be found with elongated pars.
- Post-Surgical Anterolisthesis: This type can be caused due to certain complications the patient experiences after surgery in the back.
- Pathologic Anterolisthesis: Malignancy or infection can lead to this type of anterolisthesis.
How to Diagnose Anterolisthesis?
To diagnose anterolisthesis, the doctor will conduct a physical examination that usually includes a reflex check and evaluate the individual’s symptoms. CT scans, MRI scans, and X-rays can be used by the doctor to detect and confirm a suspected anterolisthesis diagnosis. These image tests will help the doctor to examine the defects in the bone and asses the nerve damage and injuries.
Different Grades of Anterolisthesis
After the diagnosis and confirmation of the presence of anterolisthesis, the next step is to check the extent of damage done. The grading scale is used for determining how severe the condition is and choosing the right treatment option that is required. The grades are as follows:
- Grade 1: When the displacement or slippage is less than 25%
- Grade 2: When the slippage is more than 25% and below 50%.
- Grade 3: When the slippage is between 51% and 75%.
- Grade 4: When there is 76% or more slippage.
- Grade 5: Rare cases when there is 100% slippage due to the complete dislocation of the affected vertebra.
Treatment of Anterolisthesis
The treatment option suggested by the doctors will depend upon the grade of slippage. When people experience the symptoms of grade 1 and grade 2, they usually have mild symptoms and treatment is provided to alleviate the pain and discomfort. For grade 3 and grade 4, the slippage is considered severe which can require surgery. The treatment options for treating mild slippage symptoms could include a course of bed rest, pain medication and gentle exercises. In severe cases, chiropractic therapy and surgery might be required.
Conservative Treatments: It is about the non-invasive medical procedures that most doctors recommend when the anterolisthesis does not show any severe symptom. This procedure is inexpensive and can deliver complete recovery when done by a professional like a physiotherapist. Conservative treatment options include:
Rest: When the person takes a short bed rest, he/she can overcome mild cases of anterolisthesis. It can help in preventing further damage to the vertebrae and further slippage. While taking proper rest is essential, it is also important that the patient stops participating in strenuous activities and sports until the symptoms and pain subside completely. The patient can undertake this treatment at home or hospitals depending on how serious the condition is. The patient might also be unable to control bowel movements and urine. In such cases, he or she must seek advice from the doctor about the right diet to follow and what to avoid.
Physical Therapies: In most cases, this treatment option is effective when accompanied by rest. This treatment consists of well-trained physiotherapists putting the patients on physical therapies and it might also include exercises for improving the movement of the discs and relieving pain. The physiotherapist will assess the musculoskeletal dysfunctions first and then decide on the best therapy for the patient. This treatment can take a number of weeks or months even, depending upon the severity of the condition. Physical therapies can involve heat massage, postural training, electronic stimulation and such other non-invasive procedures that are useful in relieving the pain. The patient can also be recommended to take anti-inflammatory medications for preventing inflammation. They are given orally or through injections to alleviate severe pain that occurs due to anterolisthesis.
These conservative treatment methods are effective only in the case of grade 1 anterolisthesis and in grade 2 of the same. When these treatment options fail to provide effective results, the patient has to undertake surgery. Surgery is an invasive procedure that has several risks, but in most cases it is successful. Surgery for anterolisthesis is known as interbody fusion.
Interbody Fusion: In this treatment option, which is surgery, the doctor makes an incision in the back of the patient. The incision is carried out through the mid-layers of the ligaments and the muscles that are positioned on both sides of the spine. After cutting the area mentioned, the doctor will free the attachments to the spinous process and the laminae. The laminae are the flat and thin parts of the vertebral arch and the spinous process refers to the bony parts in the body that project from the back of the vertebrae. With special instruments, the doctor will then remove the tiny pieces of bones from the lamina to make the nerves visible.
Once the nerves are visible, they will be moved slightly to expose the intervertebral discs and with the medical instruments, the doctor will remove the disc through the right or left the side of the patient’s spinal canal to align the patient’s vertebra. The space that remains after removal of the disc will be filled with a bone. After filling the space between the vertebrae, the vertebrae are then fused together very carefully to make sure that it never causes another incidence of anterolisthesis in the future. To ensure this, the surgeon can even fuse the vertebrae together and stabilize them with screws and other hardware.
Postoperative Care for Anterolisthesis Surgery
After the interbody fusion surgery is complete, the patient must be hospitalized for one to five days. After the completion of the surgery, the patient might feel drowsy or nauseous because of anesthesia and might experience pain. The nurses will attend the patient frequently and check for motion and sensation in arms and legs, pulse rate, body temperature, and blood pressure. On the first day of your postoperative stay at the hospital, the doctor may ask you to dangle your feet or stand up, if possible. After two to three days of the surgery, the patient will be allowed to walk with assistance up to small distances like till the bathroom, etc. Until the goals of standing up straight with minimum assistance and being able to get in or out of chair is accomplished by the patient, the patient will not be allowed to leave the hospital because if the patient falls after a spinal cord surgery, it could be dangerous.
Medications can be provided if there is pain after the surgery for the first two to three days through your IV and once you start eating normally, oral painkillers can be provided. The doctor may also recommend a muscle relaxant to reduce muscle spasms. Great care will be taken during this period of time to ensure that there is an effective and fast recovery.
Braces after Surgery: Most people might require taking braces for supporting their backs after the surgery. These braces could be custom-made or ready-made and the physician will select the right braces for you. The length of the time for which you will wear the braces depends upon the physician’s preference and the type of surgery performed. It will be worn until good results are seen in x-rays which could at least take up to six months’ time.
Long-Term Care: After you are discharged from the hospital and you have recovered somewhat, it is important that you change some of your lifestyle practices. Any activity that could stress your spine must be avoided. Your physician will tell you about various ways to keep your spine healthy in the long term.
Who are at the Risk of Anterolisthesis?
Older people are at more risk of anterolisthesis as it usually occurs to people above 50 years of age, where women are reported to have developed anterolisthesis faster than men. Aging tends to make the bones weak and cause damage like anterolisthesis.
People who are involved in regular strenuous activities, including athletes and weight-lifters, etc., might also be at a high risk of being affected with anterolisthesis.
How to Avoid Anterolisthesis?
To avoid Anterolisthesis, a person can follow a few steps like:
- Practicing stretching exercises to strengthen the abdominal and back muscles.
- Participating in sports that do not have a risk of causing lower back injuries like swimming or cycling.
- Eating a healthy diet and maintaining a healthy weight to reduce stress on the lower back.
- Eating well-balanced food to ensure good bone density and bone strength.
In most cases, surgery for anterolisthesis is successful and usually, there is no reoccurrence of the back pain after the treatment is completed. In certain cases, the nerves might get pinched after the surgery that is when the back pain might occur post-surgery. Otherwise, being careful and taking the necessary precautions can help you in avoiding anterolisthesis completely.
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