Spondylolisthesis is one of a great number of structural abnormalities in the spine which are often blamed for creating the ideal circumstances for chronic back pain. However, evidence suggests that the vast majority of cases of vertebral misalignment are completely harmless and asymptomatic. This should be of no surprise, since medical sciences' pre-occupation with the many suspected anatomical sources of back pain have led many a patient down a long and winding road of unsuccessful treatment and failed back surgery.
Spondylolisthesis is defined as an abnormal shift in typical vertebral bone position in relation to surrounding vertebrae. It can happen virtually anywhere in the spine, but most frequently occurs at L4 or L5. Congenital and idiopathic spondylolisthesis generally entails a forward movement of L5, while degenerative vertebral slippage usually involves L4. Often, there is a defect in the bone, called spondylolysis, which precedes any actual vertebral shift. Most spondylolisthesis cases are congenital and are often not discovered till much later in life. Other cases are directly linked to traumatic spinal injury. The degenerative variety is directly associated with aging and arthritic processes which occur in the spine as a normal part of getting older.
Spondylolisthesis is rated on a standardized scale according to how far the affected vertebra has moved. The majority of cases include the lowest level of vertebral slippage, rated at less than 25%. The next most common variety is moderate slippage rated at 25% to 50%. Severe vertebral slippage is rated at 50% to 75% misalignment, while extreme spondylolisthesis is consistent with 75% to 100% slippage or more. The mild and moderate varieties are almost always harmless, although they may appear frightening when visualized using x-ray or MRI technology. Severe and extreme vertebral slippage has the potential to be problematic and even create spinal instability in rare instances. However, a sizeable percentage of advanced cases are still not a source of pain or related symptoms in many patients.
Doctors are obsessed with the Cartesian philosophy of medicine, which states that the mind and body are 2 distinct entities and should be studied and treated independently on one another. It is this philosophy which has doomed many spondylolisthesis sufferers and ironically, is also proven completely wrong when applied to treating chronic pain of any sort. Medicine has developed a host a treatment options for vertebral slippage and back pain, in general. Very rarely do any of these modalities, conservative, drastic or invasive, ever lead to a cure. Most patients are lucky to even receive some measure of symptomatic relief for all their trouble. However, it is not a wasted fact that vertebral slippage is not even discovered on purpose in many patients. It is often found when testing for some completely unrelated condition and the patient has never endured any back pain. However, once the condition is discovered, the nocebo effect of the diagnostic process sets in, creating symptoms in many people, when none previously existed. This process is well documented in the medical literature and flies in the face of the previously mentioned spirit of Descartes, by providing concrete proof that the emotional consequences of the diagnosis are directly responsible for the pain!
Patients who do have back pain which is eventually diagnosed as sourced from the vertebral slippage often go through a gauntlet of treatments only to still have pain. This is particularly cruel when the surgery used to fix the condition, spinal fusion, is one of the most barbaric and incapacitating in the entire healthcare industry. The reason for the failure of most therapy plans and surgical procedures comes down to one basic fact. The diagnosis is wrong and therefore, the subsequent treatments are bound to fail... miserably. It is all at the expense of a human soul who must endure seemingly endless pain and torture, all for nothing.
Personally, I have seen far more promising results treating spondylolisthesis patients using the same knowledge therapy principles used to treat other psychogenic pain conditions, such as TMS, ulcers, TMD/TMJ and carpal tunnel syndrome. Best of all, there is no cost and no risk from this conservative and enlightened approach to care. Descartes is long dead and so should be his antiquated theories.
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