Question: I have degenerated 4th, 5th, and L5-S1 disc spaces along with Grade 1 spondylolisthesis. I am a very active 64-year old, and I swim about 30 laps twice a week and lift weights. Am I likely to need surgery in the future for the spondylolisthesis to prevent nerve root impingement; and if so, is it now possible to use artificial discs?
Dr. Hibberd's Answer:
I doubt you will need surgery. Spondylolisthesis is the forward slippage (subluxation) of one vertebral bone over an adjacent vertebral body. Rarely, this occurs due to traumatic injury associated with spinal cord compression and neurologic deficits.
Most spondylolistesis is fixed, assymptomatic, involves L3-4,L4-5, or L5-S1 vertebrae and does NOT usually require surgical intervention. An exception is made when damage to the ligaments allows instability with further movement of the vertebrae, placing the spinal cord and nerve roots in jeopardy of damage by compression or traction.
Surgical treatment is usually reserved for acute traumatic injury, especially involving the cervical spine (neck) region, where the tolerances for spinal cord injury are much less than the lumbar (lower back) region. Thoracic spinal spondylolisthesis is very rare due to the stabilization of this region by the ribs and ribcage.
Grade 1 spondylolisthesis usually defines a stable condition that is treated symptomatically and usually does not require surgical intervention. Young patients and athletes with this condition usually have a congenital defect. Patients over 60 years of age often have osteoarthritis associated with the slippage, and the spondylolisthesis can predispose to later development of spinal stenosis which may then qualify for selective surgical treatment.
Replacement disc material has been proposed for many years, but concerns about migration and dislodgement of replaced discs has kept laminectomy and spinal fusion as the most common surgical spinal procedures performed after the simple discectomy procedures. For now, disc replacement is still experimental and certainly not without risk.
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