Find out the causes for spondylolisthesis on this episode. Who does it occur to?
Find out the probability of age group that this is likely to occur? Changes to bony tissues and the incidental finding in later years. What happens when the vertebrae slips forward? What is the function of the spine, what are the signs and symptoms of spondy.
So this is quite a mouthful, this word spondylolisthesis. Basically, it is a lower back injury that involves the vertebrae which is not a disc issue, which is what we commonly touch on, or what we more commonly see in the clinic, it’s a structural.
It’s a structural defect of the bony bits in your lower back. In my experience, it’s an injury that commonly happens in sports that are rather high impact and related to hyperextension
But just having the fracture itself. It’s only spondylolysis. Yes. So the lysis part is the fracture bit. This thesis is when the actual vertebral body because of the fracture is not free to move.
Dr Jacqueline Swiatlowski is a qualified chiropractor with over 6 years of experience. She has worked in a range of different environments including roles within the allied health industry, professional sporting clubs as well as in her own private practice. With a Master of Clinical Chiropractic from RMIT University as well as a number of additional qualifications, including Active Release Technique (ART), Animal Flow and a Certificate III & IV in Fitness from the Australian Institute of Personal Trainers, Jacqueline is an expert in movement restoration and chiropractic care. In the past she has worked alongside local athletes, including players from the Western Eagles Soccer Club, Melbourne City Soccer Club and the Coburg Lions Football Club. In her role at Jurmaine Health, Jacqueline’s main focus is treating patients and looking after their health. “Jacqueline is also a TRE provider now and can offer TRE treatments to patients.”
Episode 036: Your spine and spondylolisthesis
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This is Jurmaine Health, the center to help you achieve wellness in both your brain and body. We endeavor to encourage cross communication between health professionals for your health and well being. We bring you topics on functional neurological health such as neuro psychology, neuro behavior, neuro musculoskeletal, neuro gastro, movement is well being, metabolism and microbiome, which are also some of the services that we provide.
In today's podcast, we're going to talk to you about spondylolisthesis. We briefly touched on the subject in our back series, but today I have a special guest for you our in-house physio, Cera, who will give us more of a lowdown on the subject, as well as her own experiences with it. So Cera, welcome back. And hello.
So I'll let you get a start on it.
So this is quite a mouthful, this word spondylolisthesis. Basically, it is a lower back injury that involves the vertebrae which is not a disc issue, which is what we commonly touch on, or what we more commonly see in the clinic, it's a structural.
It's a structural defect of the bony bits in your lower back. In my experience, it's an injury that commonly happens in sports that are rather high impact and related to hyperextension. Yep, so in my case, I played, I was playing volleyball and tennis at that time, that part of my life and so you can imagine every time you go in for a serve tennis stuff just have an image of Roger Federer doing his massive back bend.
To you guys Cera's doing that exactly here. She's swinging her arms and trying to position for a serve Yeah.
Tennis season was just on so have a look. Have that image in your head so is that massive backbend that you do repeatedly over a period of time. And that from the high impact point of view, think of gymnasts jumping off a vault, and trying to land with straight legs. And guess what, a backbend. So that puts a lot of pressure in the bony structures in your lower back.
Rugby league players as well when they get tackled heavily.
But that's more like trauma, but they're also there's trauma directly, but they're also forced into extension by the collision. Yeah. I guess if we think of it like that, um, rodeo. Oh, yeah.
So that's usually the cause and mechanism of injury.
So what actually happens to the bones? More often this injury stems from young adulthood. So adolescence and young adulthood, or extremely active can potentially be extremely active. I was young, in the childhood years as well, so it's usually from an injury from your younger years. Yeah. And it can continue on into later years, especially if it's not found. A lot of the time, that's when most people start having issues with it.
When you're older and you get things like arthritis or bony changes due to wear and tear or when inverted commas. Yep, she's also doing hand signs here, and altered postures based on you know, maybe something happening around the foot and ankle. That kind of thing leading up the chain that is usually in the older generation adult population. So it's actually much rare, rarer.
It's more of an incidental finding in the later years, unless, again, in this case, we're looking at potentially an osteoporotic person, an osteoporotic elderly person that's had a fall that can still occur there. When Cera touched base on she said, it's a spinal, it's a spine defect. So it's a structural one, what we're specifically talking about is it's an actual, it's actually a little fracture that we're talking about. So it's called a pars defect. So the pars is the part that we're actually referring to. So it's the little pars, which is the thinnest part and the weakest part of your vertebrae and connects the upper and lower parts of your facets which help you move and give you your extension or extension flexion sort of thing.
So If you look at on X ray, it's seen and what we talk about on X ray, it's seen as a Scottie dog, the Scottie dog is what we're referring to, it's seen on an oblique film. So it means on an angled film on your lower back. And if we're talking about the Scottie dog, is the little image that you see that's how your vertebrae actually appear, including its little ears and mouth. And then when we're talking about a fracture being there, so if we're looking at a pars defect actually being present, it means the Scottie dog has a collar. That's the way you see it, yeah, pretty much like Cera has just referred to another type of a fracture that we referred to up in your neck, where it's a snapped neck sort of thing. It's a C2 I believe that, and in this case, she's referring to the Scottie dog having a broken neck. She's giving the pause that poor little doggie has a broken neck.
That's just also how it will appear for you guys on x rays if you if anyone's seen us for spondylolisthesis Have a look at your films again, if anyone has a spondylo, have a look at your films again.
But just having the fracture itself. It's only spondylolysis. Yes. So the lysis part is the fracture bit. This thesis is when the actual vertebral body because of the fracture is not free to move. Yeah, because it's no longer articulating with the vertebral body above and below. So, spondylolisthesis is defined by its grade at one, two, and three, based on how much it moves forward. So most of the time we think of issues in the back being like not being able to bend forward, in spondylolisthesis it's the opposite. Bending backwards actually aggravates and may increase the symptoms for this population of people. So it's a vertebral slipping forwards because of the anatomy.
So slips forward on the vertebrae below.
So because of how the vertebral bodies are shaped in the spine, it's most commonly L5 slipping on S1 due to the wedge shaped like nature, it already looks like it has a tendency to slip forward now it's got nothing holding it in place. That's why it happens. And I have the textbook of life as one slippage on the right side, my right one.
Did you have did you have a positive effect on both sides or just one side?
I think just one.
Yeah, it went that way. I only had symptoms down one side. Pain quite centrally, central and unilateral. Bend down to the leg, but we will talk about me later. So that's spondylolisthesis, it can range from. If you Google it, it's actually quite scary. Grade One, very little movement. In fact, grade one, you can still do conservative treatment.
Most of the time, it involves just getting the mechanics, your core. I don't like to use that word a lot. But yeah, your core a lot stronger because if you think about it, your abdominal muscles are the one, connected to your lower spine and getting the lower legs stronger, as well as keeping the muscle length intact. Yeah, but for grade two and three when the slippage is more severe. In fact, on films, it looks pretty scary. It looks like it's literally gonna slide off your pelvis.
So it looks, so when we're talking about grade two and three, especially grade three, if you have a look at on films, it will.
How many millimeters?
It will look like the whole of your spine is falling off your pelvis. So when it's one of the higher grades, it takes not only the vertebrae, that's actually got the pars defect going through it, but it actually takes the vertebrae above it forwards as well. So it has the potential to, unfortunately, cause paralysis if it takes the spinal cord with it as well.
So you can imagine when the spine moves, I like to think of it as a pipe. Yeah, if you have a kink in the pipe, which is what happens when the vertebra shifts forward. What's like lying in case in the pipe is actually a spinal cord. So when you have a kink you're causing a compression on your spinal cord, which then leads to the downward signs and symptoms that you would expect in a person with spondylolisthesis. Yeah, I like that analogy. Move on to signs and symptoms. Yeah. So as mentioned, if with the biggest, I guess alarm bell is the neuro symptoms due to the compression of the spinal cord. And because it's usually in the lower portions, it can get quite severe. So if you think of like from L5 down to your sacral nerves, it can the not so severe one you get numbness or change in sensation in the feeling of your skin in the legs all the way down to your toes. You can get weakness, foot drop even, right?
Yes. Anything, granted, of course, it depends on where the slippage is. So if it's higher, it may not go all the way down to your foot. But in this case, it's a case of yes, because the foot is supplied by S1 S2 nerve roots. Yes, it can happen all the way into the foot.
It can also mimic a lot of sciatica like symptoms because again, we're talking about the innovation of the
From the lumbar spine, the biggest red flags are changes in sensation in your saddle region. So that's.
The saddle region, saddle region. So the area that you're pretty much making contact with if you're sitting on a horse on a saddle.
Changes to your urinary patterns or bowel bladder controls. Yeah, so those are massive alarm bells. And usually
That's a medical emergency right there. I've stated this in multiple episodes, especially I'm pretty sure I repeated this in every single one of those back series episode, bowel bladder changes are an automatic medical emergency, especially if you lose control of either of those two.
So in terms of people with the more serious cases of spondylolisthesis. For example, grade two or three there are 4 stages, because the fourth one is 75 to 100% slippage. I lied, there's a fifth one, I can just say there's greater than 100% slippage. Dude that is like, you're paralyzed pretty well
There's nothing you can do there.
Yeah. That would have to be a medical emergency and you'd like to think if it was caught fast enough that it would not get worse.
Possible. Yeah. It has to be.
With an underline.
Wouldn't have to be if it was a direct like say a car accident or something of the sort. So with severe impact and force, it could potentially do it. Yeah.
If it doesn't get to that stage, a conservative treatment is not cutting it. The most stock standard procedure that is being done is, bracing first before we do surgery, yeah, but that's still conservative. Yeah, true doesn't do anything really.
They try it and put it, they use it as a cast. So they use it to put the body into that position. Yeah, granted bones heal regardless and for the most part, so they'd go for the option of potentially bracing someone in a position, in that position to hold it so they wouldn't be able to move at that particular segment. So they allow the bones to heal plenty of residual damage afterwards, but it looks like that's like another form of treatment as well.
I don't see it very often.
No, I think it's seen more in the States than it is seen here. I think ours automatically go to either conservative just they stay away from sports, especially contact sports, live a relatively mundane sort of life when it comes to any form of activities and then surgery. This we have we seem to have pretty much two options here in Australia for the most part.
Casting is not.
Not saying anything wrong with that. There's not anything wrong with that. But it just seems to be that that those are two modalities that we seem to be. We seem to use most commonly. Yeah.
I know in sports, especially contact sports. Here in Australia, the policy is as far as I'm aware, if it's a grade one, if it's a grade one slip, they are still allowed to play. But if it's grade two or beyond, they are no longer allowed to play. I'm fairly sure grade three, I'm confident, they're not allowed to play. It's grade two that I'm, it can sometimes be sketchy, but I'm fairly confident that even from grade two onwards, they're not allowed to play. So if the team knows about it.
Not sure about post op, post op would have to be dependent on what your surgeon would say I assume I wouldn't feel, I wouldn't think a surgeon will necessarily be confident with their spondylo patient that they just did surgery on returning to a sports they are, like rugby or something more like ice hockey of the sort.
Yeah, I think it's reckless too, to be honest but hey it's your life.
If you've got rods, rods and screws in your back or a cage for that matter, I don't think I'd be encouraging a contact sport.
So like Jackie mentioned, the hardware so that's usually what's done. They use metal hardware to literally hammer and screw it in together. Yeah, and in some cases when nerves are compromised, they might do a laminectomy so they remove the kink by cutting out that portion. Remember that hose that pipe, they just remove that bit where it's kink and just
Make space relieve the pressure on the spinal cord.
So when I said I had a guest, a special guest for you in regards to spondylo, what Cera just referred to you is pretty much what Cera just had.
So I was fortunate, unfortunate enough to have to go this two times in my life. I had it done the first time when I was 17. I was quite sporty, not accomplished in any way, just like to play. So I was involved in quite a lot of the hyperextension type sports that we mentioned earlier. For myself, it was volleyball, I played basketball too, and tennis.
What actually killed me wasn't the activities in themselves. I was doing a physical test that requires standing broad jump. So you start statically on two feet and you try to jump as far as you can. Landing on two feet. I landed with I was really reaching for it. So my legs were quite extended in front of me. And so I landed too stiff legged and the impact just went straight into my back. From then because I was young and you know people usually just brush off when a kid has like back pain. I was just given like just take some Panadol, have some rest, no PE, no physical education classes for a while. They're like no, something's not right. I can't carry my backpack. I get this, this numbness. The weakness wasn't so pronounced because it was mostly in my great toe. Yeah. So I asked to have an X ray and that's when they found out that I had the Scottie dog, the pars fracture. The Scottie dog with the collar.
On my L5, on S1 back then it was and because I had the nerve symptoms. I obviously had a compression on my nerve. The slippage of my L5 on my S1 was two millimeters then but because of my nerve symptoms, we had to do some surgery. It was school holidays had my surgery. Well so great pain was gone because they decompressed the nerve, removing the ring. I wore back brace for three months. And then I moved to Australia so there was no follow up, no nothing. So put on a lot of weight being athletic to doing absolutely nothing. I was told I can never do contact sports again. Hmm.
So you know, no basketball, I can still play volleyball because hopefully my own teammates won't come charging at me, right. Didn't really get back to any sports. Since I started running. I do a lot of running. And then gradually I did more and more. I did weight training, weightlifting, CrossFit. I got really strong and my back issue was never on my mind. In fact, we only discovered it later last year. There was a chance finding I was fine. I had no pain. I don't have differences in I didn't have any weakness down my right side at all.
But we had pain didn't we?
No. What do we have? Why do we send your for xray? Why would we have sent you xray? Why did we do for your back as well?
My wrist, MRI my wrist. Because I was there, I took the day off. It's been more than 10 years and I thought I'd check it out. Your second one will be cheaper.
Yeah the MRI.
So yeah, and you have to make a booking for this thing. So I'm like why not? And thankfully I did. Because of the laminectomy, I had no nerve pain because there was nothing pressing on my nerve. Even though I have now progressed to a grade 2/3 was about 12 millimeters now. So it has moved 10 millimeters more, which is pretty scary.
Putting this into perspective. That's probably about a quarter of the, of your vertebrae itself. Yeah, yeah.
But you know what, for the podcast image, I'll put my actual MRI image on for you. Circle the Scottie dog for you.
There's no Scottie dog because I've got no laminar. Oh, they've taken it off. We'll do a slide. So the second image will show the Scottie dog, but we don't have because we don't have MRI.
I don't have my old X ray though.
Yeah, you don't have X ray anyway.
I cannot find my words. Yeah, but we can just google it fine. So went from grade one to grade two three. So again, no surgeon would touch me because I didn't have the signs and symptoms and they're like. Oh, just don't do anything.
But like we said every morning I was waking up thinking like, what if someone just hits me from the back or some idiot bounced me one way when I'm walking down the street so it was quite scary. But eventually when we did an X ray, my spine was moving along with me. When I flex forward my spine was moving forward shifted forward three millimeter.
I see you do have an X ray.
Yeah, but still without the Scottie dog.
Bring it in might be able, might still be there.
Cool. Yeah, so that's my story. Now I've got screws and rods in my lower back, which explains my disappearance from the clinic and podcasts. Because I've been resting guys. Oh, we'll see. Hopefully I'll be back to doing what I'm doing next year. I can only start from March roughly one year. They describe it as like cement drying.
So the first three to six months it's like the top bit hardening. So you can still drive over the new freshly laid cement, but to actually be able to bear load, it will take much longer. So patience, it's very trying, I have to tell you. So that's my story, feel free to reach out if you want to hear more. This don't happen all the time. It's just one of those freak, not accident freak things that happen to some people.
Pars defect can sometimes be incidental findings and they are usually of no concern. So the spondylolisthesis part, it only becomes of a concern or it can become a concern when the slippage starts occurring.
So for the most part, they're usually just an incidental finding. Yeah, a lot of the time so this as we said right at the beginning. They found in the like the older years and that's not found as a cause for anything but it's just found there. And usually it's been something else that would have flared it up initially, and then we find that there was a previous pars defect.
And most often it will say in the x ray report saying that it's a healed, they'll say that there's a healed pars defect or there's evidence of a healed pars effect. And they do that, for the most part, they are incidental finding rather than epic culprit. Unless there's a spondylolisthesis happening, then yes, they're the culprit behind it.
Guys, we'll wrap up with that for today. If you like what we're presenting, please give us a thumbs up a like or share it with one other person whom you think we may be able to help. For those of you who are coaches, dancers or athletes, and may find difficulty with expressing or executing movement patterns. Please do connect with us on our website, which is www dot Jurmaine health.com as in Jurmaine health is spelled j u r m a i n e h e a l t h. Please socialize with us on our Facebook which is also Jurmaine Health and our Instagram which is Jurmaine Health Body. And last but not least, since this podcast is made for you, our clients, patients and fans, do let us know what else you might like to hear about. Thanks for today, guys. Thank you. See you.
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