Spondylolisthesis is a spine condition in which a vertebra bone slips outs of place onto the bone below and causes intense pain.What is Spondylolisthesis?
Spondylolisthesis is a back condition in which the vertebrae bones in the spinal column move around more than they are supposed to causing one or more vertebrae to slip out of place and impact the vertebra below. When this happens it causes compression or pinching of nerves in the spine resulting in severe pain in the lower back and legs.
Spondylolisthesis (pronounced spohn-di-low-less-THEE-sis) is derived from the Greek words for “spine” (spondylos) and for “slipping” (listhesis).What is the Difference Between Spondylolisthesis and Spondylolysis?
Spondylolisthesis and spondylolysis are both similar sounding back conditions involving the spine that often cause lower back pain. However, the two conditions are not the same.
- Spondylolysis: this condition is caused by a crack or stress fracture in the vertebrae, often as a result of physical trauma such as a car accident. The condition can cause pain in the lower back and legs by impacting or irritating nerves in the spine.
- Spondylolisthesis: caused not by a vertebrae fracture, but rather by abnormal movement causing the vertebrae to slip out of place and impact the bone below. Spondylolisthesis can sometimes be caused by spondylolysis, where the fracture of the vertebrae causes it to slip out of place.
Spondylolisthesis is classified into different types, based primarily on the underlying cause of the vertebrae movement. The 3 most common types of spondylolisthesis are:
- Degenerative Spondylolisthesis: this type of spondylolisthesis is one that results from the gradual deterioration and thinning of the discs in the spine that occurs as a person gets older. As the disks getting thinner with age they become less effective at cushioning the moving spine bones and make it more likely that the bones will slip out of place.
- Congenital Spondylolisthesis: this type of spondylolisthesis is the result of a birth defect that occurs when the spinal column of a fetus does not properly form during gestation. As a result, the baby is born with slightly misaligned vertebrae that will be prone to slip out of place later in life.
- Isthmic Spondylolisthesis: this type of spondylolisthesis is caused by spondylolysis from a crack or fracture that weakens the bone and causes it to slip out of place.
Other, less common types of spondylolisthesis include:
- Traumatic Spondylolisthesis: this type of acute spondylolisthesis is the direct result of a physical trauma that causes the spinal bones to become misaligned and slip out of place.
- Pathological Spondylolisthesis: when a disease such as a tumor in the spine or osteoporosis causes slippage.
In addition to different typing based on cause, spondylolisthesis cases are medically classified into 1 of 4 “grades” of severity. The grades for spondylolisthesis are based on how far out of its normal place the slipped vertebra bone is:
|GRADE||% OF VERTEBRA SLIPPED FORWARD|
|Grade 1||25% or less|
Treatment for spondylolisthesis is focused primarily on relieving the pain in the lower back and legs. Treatment options come in 3 levels. The first level of treatment usually involves a combination of pain and anti-inflammatory medications along with regular physical therapy sessions.
If this is not successful, the next level of treatment available is epidural steroid injections. These are strong anti-inflammatory steroids that get injected directly into the epidural space around the spine to relieve back pain. They are usually effective but only last for so long.
The final and most invasive level of treatment for spondylolisthesis is to undergo spinal decompression surgery (with or without fusion). In this procedure, the surgeon carefully removes disc and bone from the spine. This creates space and relieves the constant pressure that the out-of-place bone is placing on the nerve.Spondylolisthesis in Personal Injury Cases
Spondylolisthesis can sometimes be caused by physical trauma to the spine such as in an auto accident or slip and fall. When spondylolisthesis is the direct result of an accident that is caused by another person’s negligence, you are legally entitled to receive financial compensation for the injury.
Financial compensation for spondylolisthesis caused by an accident would include any and all medical expenses reasonably incurred in treating the condition.
This would include the cost of any physical therapy, pain medication, etc. You would also be entitled to compensation for any lost wages or income if you were unable to work because of the injury. Finally, you would be legally entitled to financial compensation for the pain and suffering associated with your condition.How Much is Spondylolisthesis Worth in a Personal Injury Case
Below are sample verdicts and settlements from actual personal injury cases in which spondylolisthesis was one of the primary injuries alleged by the plaintiff.
- $150,000 Settlement (Idaho 2020): A 60-year-old car salesman was in an accident during a test drive. The salesman’s face was struck by the passenger-side airbag, aggravating his pre-existing L5-S1 spondylolisthesis (along with other injuries). He underwent spinal surgery with fusion. This case settled for $150,000.
- $227,000 Settlement (Virginia 2020): A woman was rear-ended. She suffered a cervical sprain, cervical spondylosis, whiplash, spinal stenosis, and a right knee contusion. The woman alleged that the at-fault driver’s negligence caused her injuries. She claimed they failed to timely slow down and maintain a proper lookout. This case settled for $227,000.
- $100,000 Settlement (Washington 2020): A 60-year-old man was T-boned. He suffered a traumatic brain injury, hearing loss, tinnitus, hypersomnia, neck and back strains and sprains, lumbar spondylosis, and cervical degeneration and disorder with radiculopathy. The man alleged that the at-fault driver’s negligence caused his injuries. He claimed he failed to yield the right-of-way and maintain an appropriate lookout. This case settled for $100,000.
- $3,650,000 Verdict (New Jersey 2019): A 42-year-old man was struck by a golf cart and suffered aggravation of his pre-existing spondylolisthesis. The man alleged that the at-fault driver’s negligence caused his injuries. He claimed he carelessly operated the vehicle and disregarded other golf course patrons’ safety. The defense denied liability. They argued that the man failed to avoid the collision. The jury awarded a $3,650,000 verdict.
- $29,411 Verdict (Connecticut 2019): A man was rear-ended and suffered aggravation of his asymptomatic lumbar spondylolisthesis. The man was left with a permanent impairment rating of 10 percent. He alleged that the at-fault driver’s negligence caused his injuries. The man claimed she negligently tailgated him, excessively sped, and failed to timely brake. A jury awarded a $29,411 verdict.
- $83,500 Verdict (Minnesota 2019): A woman was rear-ended and suffered C3-4 spondylolisthesis as well as disc herniation and other injuries. The woman alleged that the at-fault driver’s negligence caused permanent injuries. She claimed she failed to control her vehicle and keep a proper lookout. The jury determined that the woman’s injuries were not permanent. They awarded her $26,500.
The most common cause of spondylolisthesis is degenerative changes in the spinal disc that occurs with age. Other causes of spondylolisthesis congenital defects and acute physical trauma such as during an auto accident or sports injury.
Treatment options for spondylolisthesis usually start out with pain medication and physical therapy, then advance to epidural steroid injections. If these treatments are not effective the only alternative is to undergo spinal decompression surgery.
If left untreated spondylolisthesis will result in increasing levels of chronic pain in the lower back and neck. Eventually, this can lead to permanent nerve damage and partial paralysis in the legs. In very rare cases untreated spondylolisthesis can lead to a spinal infection.
The L4-L5 vertebra is most likely to slip out of place with spondylolisthesis because this is the bone that has the widest range of movement in the spine. The next most common vertebra to slip from spondylolisthesis is the L3-L4, followed by the L5-S1.
Spondylolisthesis is classified into grades of severity based on how far out of normal alignment the slipped vertebra bone is. Grade 1 spondylolisthesis is the lowest grade and it applies when 25% or less of the bone has slipped out of place.
Chan, A.K., et al. "Obese patients benefit, but do not fare as well as nonobese patients, following lumbar spondylolisthesis surgery: an analysis of the quality outcomes database." Neurosurgery. 86.1. (2020): 80-87. (This study looked at the outcome of obese patients who underwent degenerative lumbar spondylolisthesis surgery. The researchers found that both the obese and control groups experienced back and leg pain relief. However, the researchers found that obese patients experienced significant symptoms compared to non-obese patients. Nonetheless, they concluded that lumbar spondylolisthesis procedures improved obese patients’ symptoms.)
Cheung, J.P.Y., Fong, H.K., & Cheung, P.W.H. "Predicting spondylolisthesis correction with prone traction radiographs." The Bone & Joint Journal. 102.8. (2020): 1062-1071. (This study looked at whether prone traction radiographs could detect degenerative lumbar spondylolisthesis corrections following surgery. The researchers found that prone traction radiographs best-predicted disc height and slip distance corrections in interbody fusions.)
DiGiorgio, A.M., et al. "Correlation of return to work with patient satisfaction after surgery for lumbar spondylolisthesis: an analysis of the quality outcomes database." Neurosurgical focus 48.5 (2020): E5. (This study looked at the association between returning to work and patient satisfaction in lumbar spondylolisthesis patients who underwent surgery. The researchers found that 85 percent of patients expressed satisfaction with surgery, while 77 percent returned to work. They also found that 72 percent of patients who did not return to work were satisfied, while only 10 percent who returned to work were dissatisfied. The researchers concluded that patients who did not return to work were likely to be just as satisfied with their surgery as those who did.)
Haddas, R., et al. "The effect of surgical decompression and fusion on functional balance in patients with degenerative lumbar spondylolisthesis." Spine 45.14 (2020): E878-E884. (This study looked at how lumbar decompression and fusion procedures affect degenerative lumbar spondylolisthesis patients’ balance and stability. The researchers found that surgical decompression and fusion reduced disability, leg and back pain, demoralization, and kinesiophobia. They also found that patients exhibited more stable stances post-surgery.)
Ravinsky, R.A., et al. "Slip progression in degenerative lumbar spondylolisthesis following minimally invasive decompression surgery is not associated with increased functional disability." European Spine Journal. (2020): 1-8. (The study looked at whether minimally invasive decompression procedures caused worsening symptoms in low-grade lumbar spondylolisthesis patients. The researchers found that there was some slip progression in most patients. However, they also found no correlation with worsening symptoms.)