The spine is made up of multiple bones called the vertebra. The spinal column in made up of 33 individual bones that are stacked upon each other. The vertebral column is divided into the following zones: cervical, thoracic, lumbar, sacrum and coccyx. The top 24 bones are moveable. Spinal discs rests between the vertebrae and act as a shock absorber between the bones. The spinal column houses a complex network of bones, nerves, tendons, muscles and ligament. Damage to any of these networks can cause pain, tenderness and functional limitations. Degenerative retrolisthesis is one such condition where the vertebra displaces and moves from its normal position and causes intense pain. Let us see the symptoms, causes diagnosis and treatment of degenerative retrolisthesis in details.
An Overview of Degenerative Retrolisthesis
Degenerative retrolisthesis is a condition characterized by displacement of the vertebra in the spine.1 There may be forward or backward slippage of the vertebrae. However, the occurrence of forward displacement is higher than backward displacement. Retrolisthesis is the opposite of spondylolisthesis, characterized by posterior displacement of the vertebral body. Disc slippage is more common in the cervical or upper portion of the spine, as the discs in this area are comparatively smaller. In majority of the cases, the disc either bursts or deteriorates which leads to misplacement of the vertebrae above the disc. This causes excessive pressure over the bone below it.
Types of Degenerative Retrolisthesis
Based on the extent of the damage, degenerative retrolisthesis are categorized under the following headings:
- Complete Retrolisthesis: Here is complete displacement of the vertebral body posteriorly.
- Stair Stepped Retrolisthesis: Here the vertebra slips backward with respect to the vertebra above it.
- Partial Retrolisthesis: Here the vertebra slips backward with respect to the vertebra below it.
Based on the extent of the posterior displacement in terms of percentage of the foramina, it is classified as:
- Grade 1 Retrolisthesis: Up to one-fourth
- Grade 2 Retrolisthesis: From one-fourth to one-half
- Grade 3 Retrolisthesis: From one-half to three-fourths
- Grade 4 Retrolisthesis: From three-fourth to total displacement.
Symptoms of Degenerative Retrolisthesis
Symptoms associated with degenerative retrolisthesis vary from person to person. Most common symptoms include:
- Constant back pain and tenderness
- Back stiffness
- Limited mobility 2
- Numbness 2
- Pain with daily activities such as while sitting, walking or standing.
Nerve damage caused by degenerative retrolisthesis can lead to numbness and tingling over the area supplied by the damaged nerves. This may be associated with weakness in arms, legs, shoulder, fingers, torso etc.
Prognosis of Degenerative Retrolisthesis
Degenerative retrolisthesis has a good prognosis. If diagnosed early, Degenerative retrolisthesis can be stabilized. It can cause impingement of nerves and cause numbness and tingling at multiple locations if not treated in time. If left untreated, Degenerative retrolisthesis can lead to various degenerative disorders.
Causes and Risk Factors of Degenerative Retrolisthesis
The common causes of degenerative retrolisthesis include:
- Degenerative diseases such as arthritis
- Congenital defects
- Back injuries and trauma
- Motor vehicle accidents
- Contact sports and extreme physical activities.
Complications of Degenerative Retrolisthesis
Degenerative retrolisthesis, if left untreated, can have serious neurological manifestations. It can lead to permanent numbness and weakness in the area intervened by the affected nerve root. It can limit mobility and can affect the ability to carry out daily functions and activities. If left untreated, degenerative retrolisthesis can also lead to bulged disc and disc herniation.
Diagnosis of Degenerative Retrolisthesis
An experienced orthopaedist evaluates the condition of degenerative retrolisthesis. A physical examination of the spine is done along with taking a detailed patient history.
To confirm the diagnosis, further specialized studies may be done. These include:
- Blood Tests to Confirm Degenerative Retrolisthesis: Certain blood tests like ANA antibody tests, rheumatoid factor test, Lyme titre etc. are done to rule out inflammatory conditions and infectious disorders.
- Imaging Studies to Diagnose Degenerative Retrolisthesis: Imaging studies like x-ray, CT scan and MRI help in diagnosing the condition of degenerative retrolisthesis.
- Electromyography or EMG to Diagnose Degenerative Retrolisthesis: Electromyography helps in studying the proper functioning of the nerve cells and muscles.
Treatment of Degenerative Retrolisthesis
Intervention by pain management specialist or chiropractor is required to manage the pain and discomfort caused by degenerative retrolisthesis. The treatment protocol includes:
- Non-Surgical Treatment for Degenerative Retrolisthesis: Non-surgical treatment includes repositioning, Robb myofascial release, nutritional supplementation, micro current therapy, water therapy etc. Apart from these it also includes the following:
- Oral Medications: Over-the-counter medications such as Advil, Aleve, and Tylenol etc. are given for reducing the pain associated with Degenerative retrolisthesis.
- Topical Medications: A number gels, ointments, creams and sprays are available which can be applied for getting symptomatic relief from Degenerative retrolisthesis pain.
- Physical Therapy: Physical manipulation of the neck helps in relieving the pain associated with degenerative retrolisthesis and also helps in improving the flexibility. However, this must only be done by an experienced physiotherapist.
- Traction: An experienced physiotherapist uses the technique of traction by stretching the neck using weights, pulleys and air bladders. This helps in reducing the pain to a great extent.
- TENS (Transcutaneous Electrical Nerve Stimulation): Electric impulses are delivered using electrodes for relaxing the muscles and easing the degenerative retrolisthesis pain.
- Immobilization: At times, the physicians advise the use of soft collar or back brace which provides adequate support and rest to the neck.
- Steroid Injection: In advanced cases, corticosteroid injections are given in the facet joint to get relief from the pain and discomfort.
- Surgical Intervention for Treating Degenerative Retrolisthesis: Surgery may be required for releasing a compressed nerve due to degenerative retrolisthesis and repositioning of the maligned bones.
- Home Care for Degenerative Retrolisthesis: Alternate application of heat and cold compresses over the affected area provides some relief. In order to improve neck and back stiffness, one can take warm showers in the morning.
- Alternative Medicine for Managing Degenerative Retrolisthesis: Alternative medicine such as massage, acupressure and acupuncture and chiropractic therapy can also provide relief from the pain and discomfort that comes in with degenerative retrolisthesis.
Exercise and Prevention of Degenerative Retrolisthesis
It is advised to stay physically active and exercise on a regular basis to avoid degenerative retrolisthesis. Physical activities help in maintaining the spine flexibility. A number of home exercises are recommended for improving and preventing degenerative retrolisthesis. These include simple stretching exercises followed by neck rolls, shoulder rolls and hip rolls and also isolation movements of each body parts to keep them active. For obtaining better results, one can take heat compress or warm shower. Special exercises may be recommended by the physician or physiotherapist based on the type and grade of degenerative retrolisthesis.
The following is recommended to prevent degenerative retrolisthesis:
- Maintaining an Appropriate Posture: It is advised to maintain the spine in the right posture while standing as well as while sitting. Slouching and hunching over increases the risk or neck pain. Maintaining correct posture while sleeping is also important to prevent degenerative retrolisthesis.
- Taking Frequent Breaks Helps Prevent Degenerative Retrolisthesis: Watching television, using mobile or tablet or working on computers for a long time must be avoided to prevent degenerative retrolisthesis. One must take frequent breaks to provide adequate rest and movement to the spine.
- Proper Workplace Ergonomics: Computers and other electronic gadgets must be used while maintaining the correct ergonomics in mind. One must use a comfortable ergonomic friendly chair in office which provides complete support to the spine. The posture must be such that the spine maintains its proper curvature, with knee below the hip level and foot rested on the ground. The computer monitor must be at the eye level.
- Avoiding Heavy Back Packs: Heavy back packs causes’ additional stress on the spine. Hence, it is advised to avoid heavy back packs; instead one can use trolley bags.
Degenerative retrolisthesis is a bone disorder characterized by posterior displacement of the vertebral body causing pain and discomfort over the back. It affects the neck more commonly than the other lower portions of the spine. It is commonly seen with increased aging, as the incidence of rupture of spinal disc increases with aging. As the disc ruptures, the vertebrae above lose support and bulges outward. It can cause nerve compression and cause numbness and tingling in the extremities. If left untreated degenerative retrolisthesis can lead to permanent deformities. Intervention by chiropractor, pain management specialist and physical therapist is beneficial. Physical therapy is often recommended. In extreme cases, surgical intervention may be required. It is advised to follow a healthy lifestyle, exercise regularly, maintain appropriate posture and follow correct ergonomics at work place for preventing development of degenerative retrolisthesis.