What is Anterolisthesis?

The vertebrae are bones that protect the spinal cord. Spondylolisthesis results from the vertebrae slipping out of position, causing a wide range of issues. Anterolisthesis is a specific type of spondylolisthesis where the upper vertebral body slips forward on the vertebra below it, usually in the low back. Depending on the degree of slippage, symptoms can range from nonexistent to debilitating.

Causes

The exact cause remains unknown, but anterolisthesis often develops following sudden blunt trauma or fracture, such as in a fall or a vehicle accident. Some people develop anterolisthesis due to long-term, strenuous exercise like bodybuilding. Others may have anterolisthesis due to aging. Anterolisthesis has some links to underlying conditions like arthritis, tumors, and weak bones, as well. Some children are born with a genetic spinal growth issue that later causes anterolisthesis.

Symptoms

Anterolisthesis symptoms can vary wildly depending on the degree of slippage and where it occurs. Some people have constant and severe pain in the affected area, while others have pain that travels down the lower back and legs. Mobility issues are common, as are muscle spasms, tingling sensations, inability to feel temperature, poor posture, and general weakness. Severe cases may cause loss of bladder or bowel function.

Physical Exam

To diagnose anterolisthesis, doctors will typically begin with a physical exam. The key sign of any kind of spondylolisthesis, including anterolisthesis, is pain with lumbar extension. Doctors may also ask their patients to perform certain maneuvers to test the spine’s range of motion and locate the source of the pain. People with severe anterolisthesis sometimes have a unique pelvic tilt that changes the shape of their buttocks.

Diagnostic Imaging

If a doctor suspects anterolisthesis, they use medical imaging to locate and accurately diagnose the condition. X-rays, MRI scans, and CT scans can all confirm an anterolisthesis diagnosis. In addition to observing the slippage itself, the scans also allow doctors to find any injuries, nerve damage, or bone defects.

Grading

When diagnosing anterolisthesis, doctors will assign a grade related to the degree of the slippage. Grade I is the most common, accounting for around 75% of all spondylolisthesis cases. The grades are

• Grade I: 0% to 25% of slippage
• Grade II: 25% to 50%
• Grade III: 50% to 75%
• Grade IV: 75% to 100%

Some doctors recognize a fifth grade, representing slippage greater than 100%.

Risk Factors

Older people, specifically those over 50, are more likely to develop anterolisthesis. The condition typically progresses more quickly in women than in men. Some people are born with thinner vertebral bones, which increases the risk of spondylolisthesis. Athletes and weightlifters are also more likely to have anterolisthesis due to the repetitive strain they place on their bodies.

Reducing the Risk

People who wish to protect against conditions like anterolisthesis have a few options available to them. Research shows that strengthening the back and abdominal muscles can provide additional support for the vertebrae. Additionally, consider sports and activities with a lower risk of injury, such as cycling and swimming. Maintaining a healthy weight also reduces stress on the lower back.

Conservative Treatment

Experts opt for more conservative treatment options for most people with anterolisthesis, and such therapies are effective in the majority of cases. This consists primarily of physical therapy that includes spinal flexion and extension exercises. Physical therapists may also focus on exercises to strengthen the core muscles. Some patients benefit from bracing along with physical therapy. Anti-inflammatory medications can help initially, though more powerful options may be necessary if the pain continues.

Surgical Treatment

Cases of severe slippage may require surgical treatments. Experts typically recommend at least three months of conservative treatment before considering surgery. Indications for surgical intervention are pain with a reduction of quality of life, worsening bladder or bowel symptoms, or worsening neurological deficits. Surgeons use both minimally invasive and open surgical techniques to treat anterolisthesis, depending on the severity of the slippage.

Prognosis

Conservative treatment options and surgeries have high success rates. People who undergo treatment for anterolisthesis often return to a healthy and active life within a few months. Rehabilitation helps those who have surgery return to full function. Experts recommend avoiding strenuous activities even after recovery.