What is QI Back & Spine Clinic?

QI Back & Spine Clinic is a team of medical professionals who are dedicated to diagnosing & treating severe, chronic or acute back and spine conditions by non-surgical methods. Diagnosing the root cause of back and spine conditions is always the first step in medicine. We use a multi-disciplinary approach to accurately diagnose the cause of back pain because the more accurate the diagnosis, the more precise the treatment. We believe that it is essential to reverse the underlying cause of back pain and not just temporarily suppress the symptoms.

How do you diagnose the root cause of back pain?

An accurate diagnosis is critical as 85% of back pain cases are termed ‘non-specific’. Your back pain can be due to a neurological, systemic, structural or mechanical dysfunction. We are amongst the first to use a diagnostic approach that covers all these aspects. We use non-invasive technology that isolates the spinal structure. The controlled guided movements test and measure the strength and mobility of the spine. We can therefore identify the root cause of your back pain and prescribe further course of treatment.

What technology do you use? Is it non-invasive?

The machines we use are non-invasive biofeedback devices. They hold and support your body in fixed positions and then measure your functional ability during movements. They allow us to get a clear understanding of your spinal muscle tissue.

Who are QI spine specialists?

Our spine specialists are doctors with a specialisation in spinal disorders post a 4-year clinical degree in physical medicine or physiotherapy. They are specialists in the prescription of mechanical medical movements. Their expertise is dedicated to the reversal of spinal disorders and to promote mobility & function.

Condition

Spondylolisthesis L5-S1: Symptoms, Causes & Treatment

QI Spine Clinic, 4 years ago

What do you mean by Spondylolisthesis L5-S1?

Spondylolisthesis refers to the condition where one lumbar vertebrae slips over the other. The word ‘spondylo’ means spine and ‘listhesis’ means slippage. Spondylolisthesis involves the forward slip of superior vertebra over the inferior other relatively, that may cause pain. About 5-6% of males and 2-3% of females suffer from spondylolisthesis. It is commonly preceded by spondylolysis, i.e. when spondylolysis is left untreated or in case of trauma.

Difference between Spondylolysis & Spondylolisthesis

Spondylolysis refers to a condition where there is a defect in a portion of the spine called pars interarticularis, i.e. a small section of bone joining the facet joints in the back of the spine. In simple words, spondylolysis means an underdeveloped or a crack or fracture in one of the vertebrae. Whereas in spondylolisthesis, the defective pars interarticularis can be only on one side or on both sides. In simple words, when the defect weakens the bones to an extent that it cannot maintain its alignment in the spine and starts shifting or slipping out of place. It commonly occurs at L5-S1.

Overview of L5-S1

Have you heard of L5-S1 and wondering what is it about? L5-S1 is the lumbosacral junction. L5-S1 is the point of transition between the lumbar spine and sacral spine in the lower back. L5 and S1 are merged by the lumbosacral facet joints along with articular cartilage. L5-S1 receives a higher degree of mechanical stress compared to the above portion and also helps in transferring loads from the spine into the pelvis and legs. Hence, it is vulnerable to traumatic injuries, degeneration, disc herniation and nerve compression.

Spondylolisthesis – Types & Grades

Spondylolisthesis is classified into six types. Type I – It is also called as Dysplastic (or Congenital) spondylolisthesis, often caused by birth defects. Type II – It is also known as Isthmic spondylolisthesis, generally occurs as a result of abnormal wear on the vertebrae from repetitive stress. Type III – It is Degenerative spondylolisthesis, commonly caused by ageing and disc degeneration. This type of spondylolisthesis usually occurs at L4-L5 region of the spine. Type IV – It is called as Traumatic spondylolisthesis, caused due to acute fracture of the posterior elements Type V – It is Pathologic spondylolisthesis caused by spinal tumours or other pathological conditions. Type VI – It is an outcome of a surgery which leads to slipping of a vertebra forward.

Signs & Symptoms of Spondylolisthesis L5-S1

L5-S1 spondylolisthesis can cause back pain as well as numbness, weakness in both the legs. All symptoms may not be prominent. It may happen that one may not feel any pain or numbness until years even after the slippage of the vertebra. However, it often manifests itself as pain in lower back or buttocks and is revealed only on x-rays and CT scans. Typically, one feels a dull ache or sharp pain in the lower back if the surrounding nerve gets compressed due to this slippage. Pain worsens with activities such as prolonged sitting, standing and repetitive lifting, bending or a jerk. According to the severity of slippage, Spondylolisthesis is graded. It is known as the Mayerding classification, which is based on how much of a vertebral body slips forward over the body beneath it. There are 5 grades, with grade 1 being the least advanced to grade 5 being the most advanced. Grade I: 25% of the vertebra has slipped forward. Grade II: 50% of the vertebra has slipped forward. Grade III: 75% of the vertebra has slipped forward. Grade IV: 100% of the vertebra has slipped forward. Grade V: Here the vertebra has completely fallen off (spondyloptosis).

Other common symptoms are: –

Lower back pain is the most common one.
Weakness in one or both thighs/legs
Pain might radiate to buttocks or thighs
Decreased ability to control bowel/bladder movements (in type IV and above)
The muscles in the back of thigh i.e. hamstrings feel tight
Difficulty in standing, walking.

Causes of Spondylolisthesis L5-S1

Birth defect
Followed by trauma

Diagnosing L5-S1 Spondylolisthesis

Your physician may go through your past medical records. Your current signs and symptoms will be checked for the diagnosis of spondylolisthesis. To confirm spondylolisthesis diagnosis, the doctor might ask you to get a few imaging tests done such as X-ray, CT scan, MRI and DSA. With the help of DSA, spine specialist will be able to highlight the exact muscles that have become inefficient and might have led to instability in the spine thus, leading to spondylolisthesis. Also it will help in designing the treatment plan.

Treatment for Spondylolisthesis L5-S1

The goal of L5-S1 spondylolisthesis treatment is to stabilize the spine, stop or reverse the slipping and pain relief. Non-surgical treatment methods are used if the slippage is not more than 50% and with no significant neurological compromise. Surgery might be used only in high-grade spondylolisthesis.

The non-surgical treatment methods include:-

Pain management

Rest – Take relative rest. Taking a break from all the strenuous activities can help in relieving the pain but it won’t reverse the condition.
Medication – You can ease your pain with the help of OTC medicines.
Injections – You might be suggested to get steroid medications/injections directly into the affected area.
Physical Therapy – Specific exercises can help you in strengthening your abdomen and back. Frequency specific microcurrent and certain exercises can relieve pain.

To stabilize the spine for a long term effect

Spine rehab & accurate treatment by targeting specific muscle – This can be achieved by exercise plan focusing on the weaker muscles around abdomen and back. Regular exercise can relieve pain.
Brace – A brace can help in stabilizing your spine. It limits movement so that fractures can heal.

Spondylolisthesis L5-S1 Exercises

Regular exercise will strengthen your spine muscles and enable you to take any excessive load. It can be any external weight that you are lifting or your own body weight. Excess weight puts additional stress on your lower back. Exercises are necessary for conditioning your spine. Specialised spine physiotherapy includes comprehensive symptomatic and functional restoration ith the use of advanced technology, identification of the exact cause and origin of pain with a precise spine function test like DSA is important.

Below are the exercises that may help in decreasing the pain.

Pelvic tilt – It strengthens your lower abdominal muscles and also stretches your lower back.
Lower trunk rotation – It increases the mobility and flexibility of your spine.
Partial curl
Pelvic bridging

Takeaway

Spondylolisthesis L5-S1 is generally not a serious condition but it may become a chronic condition and hence a cause of disability. However, you can take necessary preventive measures like exercises, a diet-rich in vitamin D3, B12, calcium and proteins and maintain your weight to reduce the risk of spondylolisthesis. You may experience relief through proper rest, physical therapy and medication.

Frequently Asked Questions about L5-S1 Spondylolisthesis

What do you mean by L5-S1?

L5 S1 stands for the lumbosacral junction. L5-S1 is the point of transition between the lumbar spine and sacral spine in the lower back.

What is the best exercise for L5-S1 Spondylolisthesis?

Low-impact exercises are recommended to enhance the healing process and reduce pain. But it is always suggested to contact the spine specialist to ask for the exercises which will suit your spine for the same.

What does spondylolisthesis mean?

Spondylolisthesis means the slippage of one vertebra over another.

What are the common symptoms of L5-S1 spondylolisthesis?

The symptoms are as follows: –

Pain in the lower back and/or associated leg pain
Pain, numbness, weakness or tingling in legs or feet
Pain that gets worse with activity
Change in posture and gait caused by hamstring tightness
Intermittent shooting pain that passes from buttocks down to legs

What are the different grades of spondylolisthesis?

Spondylolisthesis is graded according to the degree of slippage as per Meyerding classification, which is based on the ratio of over-hanging part of the superior vertebral body to the anterio-posterior length of the inferior vertebral body. Grade I (0-25%), grade II (26-50%), grade III (51-75%), grade IV (76-100%), and grade V (>100%).

What is the objective of L5-S1 Spondylolisthesis treatment?

The goal or objective of L5-S1 Spondylolisthesis treatment is to relieve pain, stabilize the spinal segment and stop further slippage of verteba. Non-surgical treatment measures are adopted if the slippage is not more than 50% and there is no significant neurological compromise.

What are the necessary diagnostic tests to be done for L5-S1 Spondylolisthesis?

In general, a few imaging tests like X-ray, CT scan, MRI are recommended. Your spine specialist may ask you to get a DSA test done.

What are the main causes of L5-S1 Spondylolisthesis?

There are many causes of spondylolisthesis like Overuse injury, sports like football, gymnastics etc which strains the lower back, Force or stress from trauma or due to growth spurt may contribute to bone breakage, which causes the vertebra to slip forward, degenerative changes, any pathology can lead to spondylolisthesis.

What are the other problems that may occur at L5-S1?

The other common problems that may occur at L5-S1 are spondylolysis, nerve compression, disc herniation, and facet joint arthropathy.

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