Dear Dr. Lowell,
My son is only 34 years old, but he has been having a lot of back pain. He went to the doctor and x-rays were taken. The doctor told my son that he had a “slipped vertebra”. What does this mean? What needs to be done about it?
It sounds like your son has the condition called spondylolisthesis. This is a condition where one vertebra in the bottom of the spine slips out of alignment with the next lowest vertebra. That is actually what the word means in Latin: “spondylo” means “spine”, and “listhesis” means “slippage.” There are several different causes for this to happen, but two are the most common. The first type, and the most common, is due to a congenital weakness in the spine. At some point during childhood the weak area can break. This usually goes unnoticed by the child, but it does start the process where over many years one vertebra slides forward slowly like a glacier. The slippage usually stops at about halfway. The slippage doesn’t usually produce pain; in fact, over five percent of all people have this problem and don’t even know it. However, some people do begin to hurt. Usually the pain begins anywhere from the late 30s all the way to the early 70s. It is mostly back pain, but it can sometimes radiate into the hips, buttocks, and thighs.
The condition is not dangerous because the slippage almost never progresses once adulthood is reached. Therefore, the treatment is usually aimed towards simply relieving pain. I have had good luck treating this with braces and therapy for muscular strengthening to help restore stability to the lower spine. Very occasionally, the pain is resistant to all conservative treatment, and sometimes surgery is necessary. The operation consists of removing the broken piece of bone and fusing the two slipped vertebrae together. This fortunately has a very high success rate.
A second kind of slippage can occur in the elderly as a result of arthritis. In this case, the two vertebrae can simply grind past each other as a result of wear and tear. In this type of slippage, pain is not usually from the slippage itself. It is usually due to nerves being pinched by the debris and kinking of the spinal canal that the slippage produces. This can also usually be treated conservatively with physical therapy, injections, and medication. If all else fails, surgery can be done to unpinch the nerves and it is usually quite successful.