Not a Regular Ache

 Not a Regular Ache

The cause of pain or numbness in your legs may not just be symptom of getting older; there could be a problem in your spineDeborah Rutledge That shooting pain down the leg and limited walking tolerance might not be simple aches and pains; it may signal a shift in the vertebrae, a condition called spondylolisthesis. Its Greek name means sliding spine, and more than 3 million people in the U.S. are diagnosed with it each year.

Typically occurring where the spine curves and bears the most weight, around L4 and L5, the vertebral bone on top is sliding forward onto the one beneath it, says Dr. Ryan Seal of the Christ Hospital Health Network.

Dr. Tann Nichols of the Mayfield Brain and Spine Clinic likens it to a shifted tower of blocks.

“If you push it, you offset those in front,” Nichols says.

The most common cause is degeneration, where the joint that holds the vertebrae in proper alignment wears out, Seal says.

Aging brings about wear and tear on the spine, causing changes such as the drying out and weakening of intervertebral disks. Disk degeneration leads to arthritis and degenerative spondylolisthesis, a condition more common in African Americans, people with Diabetes and women over 40, Seal says.

When arthritis develops, it weakens the joints and ligaments that hold the vertebrae in the proper position and the resulting slippage can narrow the spinal canal, putting pressure on the spinal cord.

This applies increasing strain to the back, and though the condition develops over time, the body naturally tries to overcompensate, which can lead to bone spurs and enlarged ligaments, Seal says.

A related condition, spondylolysis, can be a precursor but is not always. It refers to a defect, or break, in the pars interarticularis, the narrow bridge between the upper and lower facet joints of the vertebrae.

Some athletes, like gymnasts and weight lifters, develop a pars fracture through hyperextension or repetitive micro trauma, Seal says. Others simply have genetically weaker pars that can more easily lead to fractures.

Mild degrees of spondylolisthesis could remain undiagnosed if the person has no pain. In that case, it might be discovered by an X-ray for something else. But with greater vertebral slippage, the pain may reach the leg, buttocks, hamstring and foot. Higher-grade slippage can cause spondylolisthesis patients to have tingling, numbness, or weakness in one or both legs.

The slippage puts pressure on the spinal nerve root, which causes the symptoms. The discomfort tends to be worse when upright and active, but improves upon sitting. Even leaning forward, such as pushing a grocery cart, can bring about some relief, since it opens up space in the spinal canal.

The slippage can cause further degeneration, or arthritis, in the joint, pinching nerves in the neural canal. Spondylolisthesis can be detected on X-ray, CT scans and MRIs, which show the nerves, Nichols says.

Once detected, the sequence for treatment starts with conservative therapies, like physical therapy, perhaps chiropractic manipulation, and exercises to strengthen the core muscles. Non-opiate pain medications, oral steroids and muscle relaxers may be used to calm pain and nerves.

The next level of therapy might include epidural injections at the nerve root, but in the most advanced cases surgery could be a resort, except for a patient who is too old or frail, Nichols says.

Lumbar fusion surgery, which can be accomplished by accessing the spine from the front, side, back or peri-rectally, aims to both decompress the affected nerves and stabilize the joint, he adds. The procedure is a standard one, similar to a joint replacement, with about 80 percent recovery typical after three months.

“We’ve seen more and more of it as time has gone on,” Nichols says of patients’ willingness to pursue this corrective surgery. “There are more people who want to stay active and want to get [this] fixed.”

Tips for a Healthy Spine

The risk of developing spondylolisthesis increases as we get older, but there are steps people can take at any age to improve the health of their spine.

• Follow your doctor’s treatment plan, particularly if you were in physical therapy.

• Sit and stand properly—don’t hunch.

• Lift with your legs, not your back.

• Exercise regularly.

• Avoid lifting heavy objects or excessive bending or twisting.

• Attain and maintain a health body weight.

• Eat healthy.

• Don’t smoke.

• Avoid excessive drinking of wine, beer or other alcoholic beverages.

• Get plenty of rest.

Source: Vertical Health’s