Degenerative spondylolisthesis is a genetic condition of the spine. The disorder starts with a breakdown of the intervertebral disk and progresses to slippage or “listhesis” of one spinal vertebra on another. This creates nerve root compression and spinal stenosis resulting in leg pain, back pain and the inability to walk long distances. The hallmark of this condition is instability within the bones and disk of a spinal segment.
Common treatment for this disease is physical therapy, epidural injections and ultimately spinal fusion surgery. Surgery for this condition has been performed both with and without fusion. However, spinal fusion surgery clearly has superior results to non-fusion options.
A precursor to degenerative spondylolisthesis is the development of facet cysts. These cysts emanate from the facet joints within the spinal column. There are two joints at each level of the spine. The cysts begin to develop as the spine becomes unstable. The cysts fill with fluid, grow from the joint and push into the spinal nerves mimicking a herniated disk by creating leg pain or sciatica.
Patient education is very important in treating this condition. A frank discussion must take place between surgeon and patient. A simple cystectomy (cyst removal) can be appropriate, however the patient needs to understand there is a high recurrence rate.
Lumbar spinal fusion surgery of the segment is curative but carries additional risk of adjacent segment breakdown, decreased range of motion and a longer more complicated surgery. Spinal fusion surgery requires the placement of rods and screws in spine to stabilize the segment and removal of a significant amount of bone.
For example, fusion of the L4-L5 segment for a cyst at the same level will cure the cyst but will put additional pressure on the levels above and below the fusion. Thirty to 40% of patients undergoing lumbar fusion will require another surgery in 10 years.
Facet cysts are a serious spinal condition and surgery for this condition should not be taken lightly. Patients should seek the advice of a fellowship-trained spinal surgeon before undergoing any procedure.
Dr. Banco is a board-certified, fellowship-trained orthopaedic spinal surgeon. He attended medical school at Jefferson Medical College followed by an orthopaedic surgery residency at Thomas Jefferson University Hospital, both in Philadelphia. Dr. Banco performed his spinal fellowship at The New England Baptist Hospital in Boston, MA.