What is Anterolisthesis?
Anterolisthesis is defined as a forward slippage of the upper vertebral body in relation to the vertebra below. The progression in the displacement of the involved vertebra can potentially pinch the spinal nerves of the vertebra and may also result in damages in the spinal cord. Anterolisthesis can arise in any other area of the spine although it is mostly detected in the fourth and fifth lumbar vertebrae. Anterolisthesis is a form of spondylolithesis that described the manner of slippage of the vertebra.
Anterolisthesis is the condition of the spine that involves the vertebrae. The vertebrae make up the spine and are bones that form an opening to allow a passageway for the spinal cord. The spine is made up of approximately 24 articulating bones with 5 fused bones in the sacrum and 4 fused bones in the coccyx. The vertebral column is placed in the dorsal portion of the torso. The stacked up bones are separated by the intervertebral discs. These intervertebral discs are flat shaped cushions that are situated in between the 2 vertebrae. The intervertebral discs serve as a shock absorber for the spinal cord and the vertebra.
The spine provides support to the weight of the body and protects the spinal cord. It runs from the base of the skull to the pelvis. The curves of the spine give it its natural “S” shape to be able to withstand immense quantity of stress to distribute the weight of the body evenly. The spine is also divided into three regions where the slippage can be detected.
Cervical spine is the uppermost region of the spine and is numbered from C1 to C7 representing the 7 vertebrae of the cervical spine. The first two vertebrae of the cervical spine are structured to specially allow the movement of the neck.
Thoracic spine composed of 12 vertebrae and represented as T1 to T12. It is situated in the chest area and serves as an attachment for the ribs.
Lumbar spine is numbered from L1 to L5 representing the 5 vertebra contained in the vertebra. The lumbar spine bears the bulk of the total weight of the body. It is the largest vertebra that connects the thoracic spine to the pelvis.
The vertebrae of the spine are greatly involved in the process of anterolisthesis. The vertebrae allow the body movement. The forward displacement in the vertebral body will hamper the natural movement of the body that can lead to damage. Anterolisthesis or the forward slippage of the vertebral body should not be disregarded and should be corrected immediately to prevent irreversible damages that can be potentially debilitating.
Grading
Anterolisthesis is graded according to the percentage of slippage of the vertebral body. This can be identified through lateral x-ray of the vertebra using the plain radiograph. The degree of forward slippage is evaluated by comparing it to the adjacent vertebra.
- Grade I – slippage in anterolisthesis covers about 25% of forward slippage and has the least severity among other grades of anterolisthesis.
- Grade II – represents a slippage of 26% to 50%.
- Grade III – slippage in anterolisthesis is about 51% to 75% of forward slippage.
- Grade IV – slippage is between 76% to 100% of slippage and is regarded as the severe case of anterolisthesis.
- Grade V – slippage represents the complete fall off from the next vertebra.
Anterolisthesis Symptoms
The symptoms of anterolisthesis vary greatly and depend on the extent and intensity of the nerve pinch exerted by the slippage towards the nerve roots. The symptoms are also dependent on the area affected by the slippage.
Lower back pain
This is the most common symptom of anterolisthesis. Grade I anterolisthesis however mild have lower back pain symptom aside from its other symptom that may go unnoticed.
Pain
Severe pain may be localized or widespread and initially occur on the site of slippage. The muscle spasm aggravates the pain even more resulting from the inflammation of the tissue adjacent to the disc, nerve roots and spine. The pain may be perceived in one or both legs and which may also be associated with leg weakness.
Muscle weakness
Muscle weakness in one or both legs may also occur in anterolisthesis which may suggest a serious damage of the nerves in the body which requires an immediate medical attention.
Cauda equine syndrome
It is the loss of bowel or bladder control that resulted from severe nerve compression.
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Numbness
Numbness and tingling sensation in the legs is among the symptoms of anterolisthesis that resulted from nerve compression.
Decrease in motion
Decreased range of motion in the lower back may also be experienced as a result of pain due from the inflammation of the tissue in the disc and nerve roots.
Anterolisthesis Causes
The mechanical breakdown or degenerative anterolisthesis is mainly due to greater impact subjected on the spinal cord and the vertebra particularly in L4 and L5 region of the spine.
The fracture is mainly implicated in anterolisthesis and the fracture could arise from the following:
- Fall from great heights.
- High impact from vehicle collisions.
- Bullet wound from a gunshot.
- Injury from contact sports and other strenuous activities.
- Poor posture
- Defect in the portion of a vertebra.
- Cartilage degeneration
- Repetitive trauma to the vertebra resulting from strenuous activities and overexertion of the spine.
- Constant pressure from manual works.
- A defect in the bone that resulted from diseases and disorders such as growth of tumor.
Risk factors are also being considered to the onset of anterolisthesis such as:
- Advancement in age wherein the condition of anterolisthesis is common in older people.
- Occupational factor where an individual is subjected to hyperextension.
- Individuals with highly delicate and weak backbones.
- Athletes such as weight lifter and gymnasts that require hyperextension of body from lifting, jumping and from those that require large forces to carry an activity.
Anterolisthesis Diagnosis
Anterolisthesis is not visible through physical exams that doctors would require imaging tests to help determine the degree of slippage. Medical history taking is necessary for baseline of diagnosis that influences the onset of forward slippage.
Plain radiograph such as lateral X-ray will help in determining the presence of slippage through comparison with adjacent vertebra. The percentage of slippage can also be determined with plain radiograph which is also the baseline for grading the anterolisthesis in comparison to the neighboring vertebrae.
Magnetic resonance imaging and CT scan are utilized in determining the degree of nerve compression significantly to anterolisthesis. This is often required when patients have complained of leg weakness associated with pain and numbness and tingling sensation.
PET scan may also be required in determining the activity of the affected site to establish a treatment option for anterolisthesis.
Anterolisthesis Treatment
Conservative treatment is the first line of treating anterolisthesis. The mode of treatment is based on the symptoms including the age and overall health status of the patient. Conservative treatments include the following:
- Sufficient rest and sleep can help in reducing the symptoms.
- Ceasing from engaging in strenuous activities and other sports that requires large forces will help the affected vertebra ample amount to heal and reestablish without aggravating the condition any further.
- Range of motion of the lumbar spine and the hamstrings can be improved with the help of physical therapy which can also help in strengthening the core of the abdominal muscles.
- Mild pain can be helped with over-the-counter pain relievers.
- Anti-inflammatory medications can help reduce the pain and inflammation of the muscles and nerve roots of the affected vertebra.
- Epidural steroid injection or corticosteroid is beneficial to patients experiencing pain, numbness and tingling sensation in the legs.
- Hyperextension braces are also beneficial while it allows the healing process to occur by bringing closer together the two bones with the defect.
- Surgery is an option for cases unresponsive to conservative treatment. The type of surgery is dependent on the cause of anterolisthesis.
- Pars repair is beneficial to the defective portion of the bone that still shows activity.
- Decompression may be performed to generate enough room for the nerve roots. This may be associated with fusion that may be performed with or without screws to clutch the defective bone together.
Anterolisthesis vs Spondylolisthesis
Spondylolisthesis is a condition of the spine characterized by a displacement either forward or backward slippage in comparison to the adjacent vertebra. This condition is potential for spine deformity and compression of the nerve roots.
Anterolisthesis is a form of spondylolisthesis that describes a forward slippage of the vertebra. Both the spondylolisthesis are potential for spine deformity and nerve root compression if not given with prompt treatment or if left untreated.
