From the Research
Spondylolisthesis is a more severe condition than subluxation, requiring a comprehensive management approach that may include surgical intervention, as supported by the most recent study 1. Subluxation and spondylolisthesis are distinct spinal conditions that involve vertebral displacement, but they differ in nature and severity. Subluxation refers to a partial or incomplete dislocation where vertebrae lose normal alignment but maintain some contact with adjacent vertebrae. It's often temporary and may result from trauma, poor posture, or degenerative changes. Spondylolisthesis, however, is a more significant condition where one vertebra slips forward over the vertebra below it, typically at the L4-L5 or L5-S1 levels.
Key Differences
- Spondylolisthesis is classified into different types including isthmic (stress fracture in the pars interarticularis), degenerative (from arthritis and disc degeneration), congenital, traumatic, or pathological.
- While subluxation may cause temporary pain and restricted movement, spondylolisthesis often produces more persistent symptoms including lower back pain, leg pain, neurological symptoms, and in severe cases, postural changes like a swayback appearance.
Treatment Approaches
- Treatment approaches overlap but differ in intensity - subluxations may respond to conservative measures like physical therapy and chiropractic adjustments.
- Spondylolisthesis often requires more comprehensive management including activity modification, bracing, pain medications, and in cases with significant slippage or neurological compromise, surgical intervention such as spinal fusion or decompression procedures, as recommended by the North American Spine Society 2.
Recent Guidelines
- The most recent study 1 provides a guide to diagnosis and management of spondylolysis and isthmic spondylolisthesis, emphasizing the importance of comprehensive physical exam and subsequent imaging, including radiographs, CT, and MRI, in diagnosis.
- Referral to a spine surgeon is recommended for any patient suspected of having these conditions due to the risk of disease progression 1.