Grade 1 Anterolisthesis: Causes, Diagnosis and Treatment

Anterolisthesis sounds like a scary long medical name. Anterolisthesis is a condition that affects the vertebral column. It involves an alteration to the normal alignment of the spinal bones which can be caused by a lot of factors that we will discuss in this article.

What Is Anterolisthesis?

Vertebral column

Anterolisthesis is formed from two words, Ante and listhesis. Ante means “forward or front” while listhesis means “sliding down”. Therefore, anterolisthesis is the forward movement of vertebrae from the normal alignment of the spine.

Our spine is expected to have an S-shaped curvature while looking at a person from the side. The spine is divided into 5 sections:

  1. The cervical spine (the neck region) has a slightly concave curve and is made up of 7 vertebrae
  2. The thoracic spine (the upper back region) with a convex curve and 12 vertebrae
  3. The lumbar spine (the middle to low back region) with a concave curve and 5 vertebrae
  4. The sacral spine (the low back region) with a convex curve and 5 vertebrae
  5. The coccyx or the tailbone

Anterolisthesis tends to occur more in the lumbar region.

What Does It Mean To Have A Grade 1 Anterolisthesis?

Anterolisthesis is categorized according to the level of slippage. It is usually from Grade 1, which is the mildest form, to Grade 4, which is the most severe form.

A grade 1 anterolisthesis is when 25% of the vertebral body slips forward.

What Causes It?

Back pain

1. Trauma

An external force to the spine can cause a forward shift of the vertebra that experiences the force. This external force can be from a car accident, a fall on your neck or back or strenuous exercises.

2. Sprained Ligaments

Ligaments are soft tissues that join bones to each other and keeps them in place. When a ligament is stretched beyond its limit, it may cause the vertebrae to move out of place as the ligament that is meant to keep it in position has been injured. The severity of the ligament injury may determine the extent of the anterolisthesis.

The ligaments can be sprained when you wrongly lift heavy items or assume a poor sitting posture for a long period of time. Assuming this posture either shortens ligaments or overstretches them.

3.Fracture

Pars fracture is a fracture that affects the facet joints at the spine. These joints are found at the spine and are responsible for the movement of the spine. A fracture of the facet joints can cause the vertebrae to slide forward which leads to anterolisthesis.

4. Muscle Weakness

The spinal muscles support the spine and keep the spine in place. Weak spinal muscles lose their efficiency in maintaining the alignment of the spine which can lead to a forward shift of the vertebrae.

5. Degenerative Changes

As we grow older, the intervertebral discs between our vertebrae begin to “wear off” due to overuse of the spine from bending, sitting for long periods of time, and other daily movements. The disc begins to dry off and may cause the vertebrae to slip forward.

How Can You Tell If You Have It?

Poor posture

The following are symptoms you may experience if you have grade 1 anterolisthesis:

  1. Pain
  2. Muscle Spasms
  3. Tingling Sensations
  4. Muscle Weakness
  5. Muscle tightness
  6. Numbness down the arm or legs
  7. Poor posture
  8. Reduced movement at the spine

How Is It Treated?

Diagnostic Tests

X-rays and MRI are advised by your doctor or physiotherapist to know the cause of pain and the severity of the slippage of the vertebrae.

The findings from these tests will determine the treatment plan.

Rest

Bed rest and orthotic devices are usually recommended to avoid further slipping of the vertebrae. A lumbar corset is worn the lumbar spine is affected.

Sleeping on an orthopedic mattress or a hard surface like the floor may help to relieve pain as well as providing support to the spine.

Thermal Therapy

Ice is recommended for the first three days of pain as ice can reduce muscle spasms and relieve pain. Ice and heat can also be alternated after three days.

Ice therapy can be done by making ice packs or placing crushed ice or ice cubes in a damp towel and placing over your back for 15 to 20 minutes.

When alternating ice with heat, a hot water bottle may be used. Start with using ice for 15 minutes then the hot water bottle for 15 minutes.

Medications

Steroid injections are usually prescribed by doctors depending on the severity of the pain.

For mild pain, over the counter medications like ibuprofen, diclofenac or muscle relaxants can be prescribed to relieve pain and also relax the muscle spasms.

Physiotherapy

Physiotherapy for spondylolisthesis

You will be referred to a physiotherapist to help manage the symptoms and to avoid an increase in the slipping of the vertebrae.

The main goals of physiotherapy will be:

  1. Pain relief which can be done using ice, heat or electrical modalities depending on the symptoms.
  2. Prevent and correct deformities that may arise because of abnormal posturing that you may assume to relieve pain. An example is unconsciously straightening your back or increasing the concavity curve or making the curve convex to relieve pain at the back.
  3. Strengthen any weak muscles. Weak core and back muscles may increase the slipping of the vertebrae as they are not strong enough to keep the vertebrae in place.
  4. Lifestyle modifications. As mentioned in our causes earlier, poor lifting techniques or poor posture may lead to anterolisthesis. The physiotherapist will educate you in proper lifting and sitting posture and also how to modify your day to day activities to prevent further damage or more pain.
  5. Recommend orthotic devices, such as lumbar support or cervical collar, depending on the location of the slip to reduce movement at the injured site and prevent further injury.

Exercises

plank

Exercises that strengthen the core and back muscles are recommended by a physiotherapist depending on the severity of pain at the time of treatment. Exercises will be added as pain reduces.

While exercising, you have to avoid bending over as this may increase the shifting of the vertebrae. Exercises should be done with caution and should be done under physiotherapist supervision.

Some of these exercises are:

1. Core Stabilization Exercises

This is an isometric exercise of the core muscles. It does not involve any movement. This is usually recommended in the early stages.

  • Hold in your stomach (not your breath) by pulling your belly button and back towards each other
  • You will feel your chest rise
  • Hold this position for 30 seconds and release

This exercise can be done at any time of the day.

2. Plank

  • Lie on your stomach
  • Place your palms under your shoulder as if you want to do a push-up
  • Contract your abdominal muscles and slowly lift your body off the floor
  • Lift your knees off the floor so your body weight rests on your palms and toes
  • Hold for as long as you can

3. Opposite Arm-Leg Extension

  • Kneel down with your palms on the ground
  • Ensure your wrist is directly under your shoulder and your knee directly under your hips while maintaining the crawl position
  • Take out your left hand straight in front of you and your right leg straight out behind you
  • Hold for 5 seconds
  • Return to initial posture and repeat with your right hand and the left leg
  • Repeat this 10 times, 5 on each side

Surgery

surgery

Surgery is the last resort and is only recommended if the shifting continues and other forms of treatment do not work.

Surgeries like decompression surgery, which involves removing tissue or bone to reduce the compression of the nerves and spinal fusion, which involves fusing vertebrae to reduce motion at the site of the shift are the popular surgeries done for anterolisthesis.

What Are The Possible Complications?

poor lifting techniques

Looking at the little anatomy of how the spine works, an anterolisthesis, if not properly treated can lead to a lot of complications.

Some of them include:

  1. Weakness in the legs which may arise from nerve compression at the lower back
  2. Difficulty passing out urine
  3. Difficulty walking
  4. Spinal deformities which happen while trying to avoid pain

How To Make Sure The Slippage Does Not Increase

  1. Lift properly. Lift with your legs bent and not your back. Ensure whatever you want to lift is not too heavy.
  2. Maintaining proper posture
  3. Go on stretch breaks especially if your job involves a lot of sitting
  4. Have an active lifestyle. Maintaining an active lifestyle will involve sticking to the WHO guidelines based on your age group and will also ensure you strengthen your abdominal and back muscles.
  5. Avoid any activity that will involve you bending forward from your waist like doing your laundry or sweeping.

In Conclusion

Grade 1 anterolisthesis is a mild form of spondylolisthesis and can become severe if care is not taken. Kindly see a doctor or a physiotherapist when the symptoms begin to show. Do not wait until it becomes a serious issue. The shift may not be corrected but it prevents an increase in slippage which may cause the complications mentioned earlier.

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Adekanmi Lipede, M.Sc, MPH

Adekanmi Lipede is a licensed physiotherapist with a Master's degree in physical activity and public health from Loughborough University. She joined 25 Doctors in 2018 and is passionate about educating people about the best steps to take when trying to be physically fit or when recovering from a mobility-related condition. For fun, she loves to exercise and read.
Adekanmi Lipede, M.Sc, MPH