Back Pain Bones / Orthopedics

Anterolisthesis: Symptoms, causes, and treatment

Anterolisthesis is an abnormal alignment of bones in the spine and usually affects the lower back.

It occurs when an upper vertebra slips in front of the one below. Pain is often the first symptom of anterolisthesis.


Misaligned vertebrae can pinch the nerves, and this can have painful and debilitating consequences. Other parts of the body, such as the arms or the legs, can also be affected by anterolisthesis.


The amount of slippage is graded on a scale from mild to severe. Treatment can range from bed rest to surgery. Anterolisthesis is often known as spondylolisthesis.





Causes


weight lifting
Anterolisthesis may be caused by a sudden blunt force or may be caused by strenuous physical exercise over time.


Anterolisthesis is often due to sudden blunt force or fractures. These can be the result of trauma typically experienced in an auto accident or a fall. Anterolisthesis can also develop over time through strenuous physical exercise, such as bodybuilding.


Aging is another common cause of anterolisthesis. This occurs naturally over time as the cartilage between the vertebrae weakens and thins.


Anterolisthesis can also be linked to underlying conditions such as weak bones, arthritis, or tumors. A tumor can force the vertebra to move from its natural position.


Occasionally, anterolisthesis is linked to a genetic spinal growth defect in children.




Symptoms


The symptoms of anterolisthesis will depend on the amount of slippage and the part of the spine where the slippage occurred.


Anterolisthesis can cause constant and severe localized pain, or it can develop and worsen over time. Pain may be persistent and often affects the lower back or the legs.


Mobility issues due to pain can lead to inactivity and weight gain. It can also result in loss of bone density and muscle strength. Flexibility in other areas of the body may also be affected.


Other symptoms of anterolisthesis include:


  • muscle spasms

  • pulsating or tingling sensations

  • inability to feel hot or cold sensations

  • pain and poor posture

  • weakness

In severe cases, the following symptoms may occur:


  • difficulty walking and limited body movement

  • loss of bladder or bowel function

Diagnosis


spondylolisthesis
Suspected anterolisthesis may be diagnosed using X-rays, CT scans or MRI scans.


A doctor will diagnose anterolisthesis using a physical examination and an evaluation of the person’s symptoms. The examination will usually include a reflex check.


X-rays, CT scans, and MRI scans may be used to confirm a suspected anterolisthesis diagnosis. These imaging techniques are used to examine bone defects, and to assess injuries and nerve damage.


Grading


The next step after diagnosis is to establish the extent of the damage. The following grading scale is used to determine the severity of the condition and what treatment is required.


  • Grade 1: less than 25 percent slippage

  • Grade 2: 26 to 50 percent slippage

  • Grade 3: 51 to 75 percent slippage

  • Grade 4: 76 percent or more slippage

There are rare cases of 100 percent slippage when the upper vertebra completely slips off the one below.




Treatment


Doctors base a treatment plan on the grade of slippage. People with grade 1 and 2 slippages usually have mild symptoms, and the treatment aims to alleviate pain and discomfort. Grade 3 and 4 slippages are considered severe and may ultimately require surgery.


Treatment options for mild slippage may include a short course of bed rest, gentle exercise, and pain medication. Severe cases may require chiropractic therapy and surgery. Surgery is considered a last resort.


Rest


Bed rest can help overcome mild cases of anterolisthesis. Participation in sports and strenuous daily activities should be stopped completely until the pain subsides.


Rest can also help prevent further slippage or damage to the vertebrae.




Medication


Non-steroidal anti-inflammatory drugs (NSAIDs) can be used to help treat the pain and inflammation caused by anterolisthesis.


For more acute pain, steroids and opioids may be required. Epidural steroids injected directly into the back may reduce inflammation and ease the pain.


Therapy


Complicated symptoms may be treated with physical therapy, often alongside an exercise program.


A brace or back support might be used to help stabilize the lower back and reduce pain. Chiropractic treatment may even help move the vertebra back into its original position.


Exercise


Exercises are usually carried out in conjunction with physical therapy. Exercise can increase pain-free movement, improve flexibility, and build strength in the back muscles.


Stabilization exercises can maintain mobility of the spine, strengthen the abdominal and back muscles, and minimize painful movement of the bones in the affected spine.


Surgery


Surgery is a last resort in the treatment of anterolisthesis. It may be necessary if the vertebra continues to slip or if the pain persists despite other treatments.


Surgery may involve adjusting the vertebrae with plates, wires, rods, or screws.


Usually, one of the following surgical procedures is used to treat anterolisthesis.


  • Decompression, where bone or other tissue is removed to release pressure on the vertebrae and associated nerves.

  • Spinal fusion, when a piece of bone is transplanted into the back of the spine. The bone heals and fuses with the spine. This creates a solid bone mass that helps stabilize the spine.

A combination of decompression and spinal fusion may also be considered.



Risk factors


older lady doing water aerobics
Low impact sports such as swimming and cycling may reduce the risk of developing anterolisthesis.


Older people are more likely to be affected by anterolisthesis. It usually occurs in people over 50 years old, with women reporting a faster rate of development.


The natural aging process causes the bones to weaken and to become more susceptible to damage, including anterolisthesis.


People who engage in regular strenuous activity increase their risk of acquiring anterolisthesis. These include athletes and weightlifters in particular.


The risk of anterolisthesis can be reduced by:


  • strengthening the back and abdominal muscles

  • participating in sports that minimize the risk of lower back injury, such as swimming and cycling

  • maintaining a healthy weight to reduce stress on the lower back

  • eating a well-balanced diet to help maintain bone strength


Outlook


According to some sources, non-surgical treatment for mild cases of anterolisthesis is successful in about 80 percent of cases. If the bones are not pinching any nerves, there might never be a recurrence of back pain after treatment.


In cases where the nerves are being pinched after bone slippage, there is a risk of permanent nerve damage. This may cause continued or recurrent back pain even after treatment.


Some researchers state that surgery is successful in relieving symptoms in 85 percent to 90 percent of severe cases of anterolisthesis.

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