It is a condition that, if neglected, carries the risk of partial paralysis.
Today, it is treated with contemporary methods of surgical treatment, using the smallest incisions with the greatest possible surgical accuracy.
Spondylolisthesis is the displacement (sliding) of one vertebra over another. As a result, the lumen, which is formed at the back of the vertebrae, narrows dramatically resulting in pressure on the nerves and causing spinal stenosis.
Spondylolisthesis can occur as early as adolescence, but most patients start to deal with their problem much later, between the ages of 40 and 50.
It is a cause of back pain and stenosis with a very specific anatomical feature, which usually needs further intervention.
Yes. The most typical form of vertebral spondylolisthesis is due to a small fracture in a critical area of the vertebrae, which creates this instability and allows the anterior slip of the vertebra due to gravity.
In congenital spondylolisthesis, the patient has a cognetical disorder, as well as degenerative spondylolisthesis, which worsens due to the natural wear and tear of aging.
In extreme cases of neglect, spondylolisthesis can cause severe neurological symptoms, which lead to partial paralysis and loss of bladder and bowel control.
The first symptom is back pain. In young people it can cause muscle spasms especially in the adductor muscles and as a result teenagers with this problem walk with tight adductors, bent knees and lean forward.
Once the nerves begin to be pressed, then the symptoms are pain, tingling and weakness in the legs.
The diagnosis of spondylolisthesis is made with a simple x-ray and possibly with a CT, as the latter depicts better the fracture in the critical area of the vertebrae in cases where an X-ray is not so clear.
If there is pain in the legs, an MRI is needed to show which nerves are being pressed and to what extent.
In the milder forms, conservative treatment is followed, during which the patient is given anti-inflammatory and analgesic drugs, while at the same time physiotherapy is recommended. The latter is very important because especially in young people, their muscular system may help with the bone problem to some extent. If patients manage to have a good muscular system around the “area” of the problem, then they achieve a natural “splint” around the vertebrae, which helps significantly.
If this treatment fails or the problem is severe, then surgery is the only solution.
Spondylolisthesis is an anatomical problem and requires an anatomical solution. Simply put, the normal shape of the spine should be restored, its abnormal mobility should be stopped and the nerve compression by the sliding vertebrae should be completely decompressed.
This is achieved exclusively with spinal fusion surgery.
There is the classic open spinal fusion method, in which we cut the muscles and expose the bone from behind. Then we place the pedicle screws, realign the spondylolisthesis, decompress the nerves and stabilize the system in the right position.
The current trend is to also remove the disc completely and replace it with an implant and a support cage.
However, all these can be also done through holes with the help of X-ray and navigation devices, special tools and special implants, which ensure a minimally invasive approach.
The next step in the development of spinal fusion is the use of robotic technology to position these implants in the safest possible way and with the smallest possible incisions. Robotic surgery ensures minor surgical trauma with the utmost precision.
Implants are keeping up with the most advanced technology. Special cages are inserted into the vertebral discs, which open inside the disc allowing the surgeon to easily reach the area.
This implies less trauma and greater safety during the operation.
There are also new implants regarding spinal fusion screws, which allow the attachment of the screws through smaller incisions, further helping in the minimization of surgical trauma.
All surgeries for the treatment of spinal stenosis are performed under general anesthesia.
Spinal fusion surgery requires hospitalization of 1 to 3 days, depending on the patient’s condition.
The return to normal activities after spinal fusion surgery is always gradual.
A patient with a non-manual work can return to his tasks, 6 to 8 weeks after surgery.
Then, if all goes well, the patient can return to heavier work six months after surgery.
However, the safest is to return to full activities after one year, because then the implant will have been replaced with bone, which will be compact enough to withstand all types of strains.
It should be emphasized that the surgeon creates the right conditions for the spinal fusion to take place, which is normally done by the body itself.
Spinal fusion is generally a very safe operation, one of the safest spine surgeries. However, there is a minimal chance of complications related to surgery.
The most serious complication is partial paralysis, which however occurs in less than 1% of the cases.
Another complication, which can occur in all surgeries, is the risk of an infection, against which antibiotics are administered prophylactically.
The failure of a spinal fusion operation can be due to two reasons:
Either because no spinal fusion took place, a possibility that increases sharply if the patient smokes, or because the implants were not placed correctly.
In both cases there is a need for revision of the first surgery.
It has been observed that surgeons who do not perform these surgeries very often, have a higher rate of failure and revision compared to those who perform a high number of these surgeries.
The success rates of spinal fusion surgery by an experienced surgeon are over 90%, including cases in which the patient does not comply with the instructions given and continues smoking.
Dr. Starantzis has been highly trained in centers abroad and has extensive experience of numerous surgeries at the University Hospital of North Midlands, in the United Kingdom.
Dr. Starantzis offers patients with spondylolisthesis the most contemporary and safe method to deal with the problem.