Anterolisthesis – Causes, symptoms, diagnosis, Grades, treatment with exercises

Anterolisthesis - Causes, symptoms, diagnosis, Grades, treatment with exercises

What is anterolisthesis?

The word “Anterolisthesis” is derived from two words ante, a Latin word and listhesis, a Greek word. “Ante” means the front and “listhesis” means slippage. Therefore the word “anterolisthesis” means the forward slip or the forward displacement of the spine. It is a form of spondylolisthesis. Spondylolisthesis consists of two types and they are anterlisthesis and retrolisthesis.

Retrolisthesis is the backward discplacement of the vertebrae in relation to the rest of the spine.

Anterolisthesis is a common problem following accidents, and falls, especially in those with weak, osteoporotic bones. This condition is very painful and the symptoms can range from mild to severe.

Anterolisthesis - Grading, Symptoms, Treatment, Causes, Diagnosis

What are the causes of anterolisthesis?

Before getting on with the causes of anterolisthesis, it is important to learn about the anatomy of the spine. With the knowledge about the anatomy of the spine, the causes of anterolisthesis can be well understood.

Anatomy of the spine

Anterolisthesis – Pictures ,Symptoms, Causes and Treatment

The human spine is made up of 33 individual bones which are place on one upon the other as a stack. The spine comprises of bony vertebrae separated by intervertebral discs. The spinal cord runs within the vertebrae. The main function of the vertebral column is to protect the spinal cord which runs inside of it. Between the vertebrae, nerve endings too come out to supply the body organs and therefore if there is any form of damage to the vertebral column, both the spinal cord and these nerves can get damaged; Nerves are most commonly damaged and thus affects the nerve functioning of the body organs.

When the vertebral column is viewed from the side, it appears as a natural “S” shaped curve. The importance of this “S” shaped curve it to allow the body to maintain balance, protection, shock absorbent, and also to perform a wide range of movements.

The spinal column is divided into 5 main regions and they are the cervical, thoracic, lumbar, sacral and the coccygeal vertebrae.  The cervical spine makes up the first 7 vertebrae in the vertebral column and these vertebrae are named as the cervical vertebrae. The main function is to provide support to your head as it is very heavy, weighing nearly about 10 pounds.

The thoracic spine consists of 12 thoracic vertebrae and is arranged in a convex curve. The reason for having 12 thoracic vertebrae is to provide its main function of holding the ribs or the thoracic cage and to maintain and protect the lungs and heart which are the major organs in our body.

The lumbar spine consists of 5 vertebrae numbered L1 to L5. These vertebrae are attached to the tail bone (sacrum) at the lower end of the spine.  The main function of the lumbar vertebrae is to support the weight of the body and that is why the lumbar vertebrae are larger compared to the cervical and thoracic vertebrae. These lumbar vertebrae are also responsible to prevent injury especially when a person lifts large and heavy objects. The sacral vertebrae lie above the coccyx in the vertebral column. There are a total of 5 sacral vertebrae which are joined together and hold the pelvic girdle together. The coccygeal vertebrae are the last group of vertebrae in the vertebral column. It is comprised of four bones which are fuse to each other and its main function is to provide connection to the ligaments and the muscles that make up the pelvic floor.

anterolisthesis grading

In between these vertebrae is the intervertebral disc. The intervertebral discs act as a cushion and absorb shock. The disc is made of an inner soft gelatinous tissue and an outer thick strong layer.

Anterolisthesis can occur in any region of the vertebral column but usually the common site of anterolisthesis is between the fourth and the fifth lumbar vertebrae. The displacement of these vertebrae can compress the nerve roots coming out at that respective level and produce signs and symptoms according to which organs the nerves supply.

There are 5 main causes for anterolisthesis and they are:

  1. Increasing age – This is the number one cause of anterolisthesis. The reason why this is so is because the cartilage between the vertebrae becomes weak as a person ages and thins over time.
  2. Trauma – Trauma or injury to the back can cause the vertebral body to move out of it position. The most common form of trauma that can lead to anterolisthesis is a fall on your back.
  3. Genetic factors – There are some cases, where there is an associated defect in the growth of the spine during their development. This is a genetic condition and therefore will be identified during childhood.
  4. Overuse – Over use of the bones in the vertebral column can also lead to anterlisthesis and this can be seen in body builders and weight lifters.
  5. Tumors on the spine – Any form of growth or tumor arising from the spine can also force the vertebra to move forward and go out of it position resulting in anterolisthesis.

What are the symptoms of anterolisthesis?

The most common and very first symptom experienced by all patients with this condition is severe pain. The intensity of the pain will vary from person to person. Both the intensity and the site of the pain depend on the position of the vertebral column where the slippage of the vertebral body has occurred.

The other signs and symptoms of anterolisthesis include:

  • Severe pain localized to the site where the slippage has occurred
  • Muscle spasms making your back feel tight and unable to move as a result
  • Tingling sensation
  • Weakness
  • Pain radiating down the leg, if a particular nerve, especially the sciatic nerve is compressed.
  • Loss of bladder and bowel control – These patients may pass urine or fecal incontinence. If this is present, then these patients require immediate medical attention.

How is anterolisthesis diagnosed?

When you consult your health care provider regarding the back pain, they will take a detailed history and do a complete physical examination to confirm the diagnosis of anterolisthesis. Following this, they may order imaging studies such as x rays to confirm the bony defect. A CT scan and a MRI scan can also be done as they are useful to show the levele of the injury and if there is any nerve damage or not.

Once the diagnosis of anterolisthesis is confirmed, the severity of the disease should assess. This is done by using an anterolisthesis grading scale which includes grades one to four. This grading system is given below:

  • Grade 1 (less than 25% displacement)
  • Grade 2 (5 to 49% displacement)
  • Grade 3 (50 to 74% displacement)
  • Grade 4 (75% to 100% displacement)
  • Grade 5 – a complete fall off from the next vertebra.

Grades of Anterolisthesis and Its Treatments

How is anterolisthesis managed?

The management of anterolisthesis depends on the severity of the condition. In other words, it depends on the grade of displacement of the vertebrae. Grade one and two indicates mild disease and in such cases requires only symptomatic treatment. However, grades 3 and 4 are considered severe disease and may require surgery.

Rest

Bed rest is the number one step in the management of mild cases of anterolisthesis. Bed rest does not mean strict bed rest. During this time, you have to do exercises that maintain the mobility of the spine and limbs. If not, other complications of too much bed resting can develop. The reason for bed resting is to prevent further displacement of the vertebrae.

If the pain you are experiencing is very severe, then you may require hospital admission.

Pain relief with analgesia

Although bed resting will help to reduce the pain, it is not true in all cases. Therefore the rest of the patients with anterolisthesis who complain of pain despite bed resting and exercises, analgesia may be required. Drugs like Non-steroidal anti-inflammatory drugs can be bought over the counter and will help with pain relief. However, if you feel that NSAIDS alone does not relieve the pain, and then ask your doctor and they will prescribe stronger analgesics such as opioids and steroids.

Physiotherapy

Phystiotherapy is the next most important step in the treatment of anterolisthesis. These exercises are targeted to improve the strength of your back muscles so that further support is provided to the spine.

Surgery

Surgery is indicated in more severe cases of anterolisthesis or in cases where medical treatment has failed to control the symptoms and signs. This surgery is aimed to adjust the vertebrae in the right position or to support the spine with internal fixation, using metal plates, rods, wires or screws.

What can I do to get rid of my back pain?

A back pain is the last thing on the list you would want to have. It could ruin your whole day and postpone a lot of planned work. Unlike a headache, a back pain is not something that you could just ignore and continue to work with. There are several ways that you could help yourself to get rid of the back pain. Apart from pain killers, some home remedies can also help you to get rid of the back pain and strengthen your back.

  • Stretching to reduce the back pain

Stretching can help you to ease your back pain by 2 main ways. First, it helps to realx the back muscles and next to strengthens your back muscles. However, forceful stretching that causes pain can do more harm than good. So it is best to speak with your health care provider and learn about the exercises that suits your body. When you get used to these stretching exercises, you can reduce your back pain quickly.

  • Maintain the correct posture to avoid back pain

With today’s development in technology, almost every one of us spend more than half of the day seated in front of the computer or television. While we do this, we do not think about how we really sit and this is one of the most common causes of back pain. Our posture can be the reason why many of us develop a back pain. Therefore it is important to concentrate on our posture when we sit for hours and hours. Aligning your vertebral bones like a stack of building blocks is lined.

  • The way you sleep

The way you sleep also helps you to relax your back muscles. The best recommended ways are to sleep on your back. But if you fall asleep on your side, keeping a pillow between your legs can help the muscles of the back to relax. Try to avoid sleeping on your stomach as much as possible as this will worsen your back pain.

  • Go for a back massage

Go to a spa and get a massage. If you can’t afford it, ask your partner to apply some ointment and give a good back massage. Massaging helps to relax the tensed muscles of your back.

  • Apply some ointment on the back.

There are so many ointments available to relieve your pain. Even though some of these ointments have a very strong smell, they are very effective and can reduce the back pain. So try applying these ointments and see if there is any change.

  • Pain killers

If none of the above remedies help you to relieve your back pain, take some over the counter pain killers or gels to reduce the pain. If you have been taking pain killers for a long time, it would be best if you visit your health care provider to get a check up done. This chronic use of pain killers may have more side effects and cause further problems.

7 simple exercises for your lower back pain

Follow these simple exercises to relieve your back pain.

  1. Standing hamstring stretch

This exercise will help to stretch your hamstrings as much as you can while as well as incorporating balance. From the standing position, place one foot forward with the heal on the floor and the toes pointing towards the roof. Next bend your back knee supporting both your hands on the back knee. While doing this, it is important to keep your back flat. You will feel the hamstrings of the stretched leg. Stay this way for about 30 seconds and then repeat the same with the other leg.

  1. Cat and camel exercise

Cat and camel exercises are done on your knees. So get down on your knees and place your hands on the floor. Keep your back straight. After positioning yourself this way, the first thing you should do is to arch you back upwards flexing your abdomen. Just like a cat arching the back upwards. Hold in this position for about 3 seconds. Then pull your back down and stick your rear end out. You will feel the stretch on your lower back. Hold this position for 3 seconds. Repeat this exercise. Do at least 5 repetitions up and down.

  1. Pelvic tilt

A pelvic tilt exercise is really good for your buttocks and the lower back. First, lay down on the floor on your back. Knees should be flexed at least 90 degrees or so.  Place your feet at the same width as your shoulders. Place your arms down by your side. First squeeze your buttocks and then raise your pelvis towards the roof. Then slowly bring down your pelvis while you loosen your buttocks and tap on the ground and go right back up, squeezing your buttocks as hard as you can. Repeat the exercise and do at least 15 to 20 repetitions.

  1.  Extension exercise

Lie down on the floor and roll on to your stomach facing downwards towards the floor. Prop yourself up on your elbows. Next push up all the way up onto your arms. Now stretch your arms and stretch your back as much as possible while keeping your hips flat on the floor. Maintain this position for about 30 seconds and do at least 3 repetitions.

  1. Side plank

Start with lying on your side keeping your arm in a 90 degree angle. You will be resting most of our weight mostly on your wrist and elbow. Try not to put pressure on your shoulders. Place your knees on the floor and stack your legs on top of each other. Now lift from your hips and maintain this position for a few seconds.

  1. Partial curl up exercise

Lie down on the floor completely flat and bend your knees to 90 degrees. Extend your arms towards the knees elevating your shoulders off the ground. Hold this position as long as you can. Now relax and return back to the floor. Repeat this.

  1. Bottom to heel stretch

This is a very gentle lower back stretch which helps to stretch the lower lumbar vertebrae. Position yourself by kneeling on all fours. Place your hands under your shoulders. Placing your arms slightly in front of you, slowly push your bottom backwards until it touches your heels. Do not arch your back upwards, keep it straight. Place your head between your arms and you will feel the stretch in your lower back. Hold this stretch for about 5 seconds and return back to the starting position. Repeat this exercise 10 times.

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Thilini Gunawardane
About Thilini Gunawardane 28 Articles
I am a final year medical student and I'm currently doing my clinical rotations in a private hospital. A huge people-person, an open minded who spent several years in the field of Medicine. I am at my final year on Medicine and clinical rotations at a Hospital (Dr Neville Fernando Teaching Hospital (NFTH). My long term run is to be a consultant one day and serve everyone in need. This has always been in my bucket list and I myself as a go-getter, will make my promisses and prove it to my self. Every-day I wake up knowing how little I know and I work for it. I learn, I use all my sources I have. Working online, I have gained so much experience and learned many things that a person should have in a working environment, time/project management, satisfying the client, meeting deadlines on time.

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