What is Retrolisthesis?

Retrolisthesis, or backward vertebral slippage, is a relatively rare joint dysfunction in which the spinal vertebra slips backward over the one below it, causing misalignment of the spine. A vertebra is a small bony disc that forms the vertebrae, which is a series of small bones with many projections for articulation and muscle attachment, as well as a hole through which the spinal cord passes. Retrolisthesis can occur as a result of birth defects, spinal injuries, arthritis, degenerative spinal disorders, nutritional deficiencies, etc.

Retrolisthesis can sometimes be confused with spondylolisthesis (also called anterolisthesis). Both of these conditions involve a vertebral body slipping over the one below. However, the main difference between them is the direction of the slippage. Retrolisthesis is a backward or rearward slippage whereas spondylolisthesis or anterolisthesis is a forward or frontward slippage. Another word for retrolisthesis and spondylolisthesis is vertebral displacement.

Retrolisthesis is more commonly found in the cervical spine (cervical retrolisthesis), thoracic spine, and lumbar spine (lumbar retrolisthesis). The vertebrae, discs, tendons (fascia), ligaments, muscles, and nerves of the spine may be involved in retrolisthesis. It can cause symptoms associated with other spinal conditions such as facet joint dysfunction, spinal stenosis, intervertebral disc bulge or lumbar disc herniation, and cauda equina syndrome (lumbar spine).

Types of Retrolisthesis

Retrolistheses are categorized into three types. They’re dependent on the vertebra’s displacement in relation to the adjacent vertebra.

1. Complete Retrolisthesis:

Complete retrolisthesis occurs when one vertebra shifts backward, in comparison to the spinal segment above and below it.

2. Partial Retrolisthesis:

This occurs when one vertebra moves backward i.e. towards the spinal segment above or below it.

3. Stair-stepped Retrolisthesis:

A vertebra moves rearwards or backward in relation to the spinal segment above it and ahead of the one beneath it.

Is retrolisthesis serious?

If it’s diagnosed early, this disorder can be stabilized, but if not, it can worsen and lead to certain complications. If left untreated, it can lead to cervical spondylotic myelopathy (CSM), or spinal cord compression, particularly in people over the age of 50. As the nerves become compressed, the following symptoms can occur:

1. Pain in the neck
2. Difficulties in balance and coordination
3. Numbness and weakness in the hands and arms
4. Reduced mobility

Retrolisthesis Grade

Based on the seriousness of percentage of backward or posterior displacement of the vertebral body’s foramen or neuroforamen, retrolisthesis is graded from 1 to 4, just like in spondylolisthesis. The grade of a retrolisthesis is critical in determining the instability of the adjacent facet joint.

• Grade 1 Retrolisthesis: a posterior or backward displacement of up to 25% of the IVF (intervertebral foramina) is considered as Grade 1.
• Grade 2 Retrolisthesis: a posterior or backward displacement of up to 25 to 50% of the IVF.
• Grade 3 Retrolisthesis: a posterior or backward displacement of up to 50 to 75% of the IVF.
• Grade 4 Retrolisthesis: a posterior or backward displacement of up to 75 to 100% of the IVF.

Causes of Retrolisthesis

There are a variety of problems associated with the spine that may trigger or lead to the onset of retrolisthesis. Retrolisthesis occurs when there is a decrease in the height of the intervertebral discs, with a corresponding loss of disc space. Scientists aren’t sure what causes the intervertebral discs to shorten, but they suspect the following causes that may affect the spine’s structures, leading to retrolisthesis:

• Birth defects in children
• Arthritis (such as osteoarthritis and spondylosis)
• Injuries of the spine (such as fractures and spinal cord injury)
• Nutritional deficiencies of the substances that keep bones strong and repair discs, nerves, and cartilage.
•  Degenerative spinal disorders ( like degenerative disc disease)
• Osteomyelitis or bone infection
•  Osteoporosis spinal injury
• Infections in the bone or blood
• Core muscles that aren’t strong enough to keep the back stable
• Traumatic fractures and stress

Retrolisthesis may be more common than previously thought. According to studies, retrolisthesis can be found in up to 30% of extension radiographs of patients with chronic low back pain. Retrolisthesis has been linked to disc degeneration, a reduction in lumbar lordosis (inward curve of the lumbar spine), and vertebral endplate changes.

Signs and Symptoms

The severity of retrolisthesis symptoms varies greatly, depending on certain factors like the grade of vertebral displacement, where the slippage occurs, how the neighboring structures are affected by the backward or posterior slippage and your overall health. Some signs and symptoms may include:

• Uneasiness in one specific area of your back
• Back pain and impaired back function
• Limited range of movement
• The displacement can be felt by the hand
• A bulge in the spine
• Other types of pain in the area of displacement
• Neurological symptoms like numbness, weakness or tingling sensations in the region of displacement which may spread to other parts of the body like arms, shoulders, buttocks, hips and legs
• Abdominal muscle weakness

How to diagnose Retrolisthesis?

A physical exam and neurological assessment are used to diagnose retrolisthesis, which provides the doctor knowledge about the medical history and symptoms of the patient. If the doctor suspects retrolisthesis after the examination, a lateral X-ray imaging may be recommended. A lateral X-ray of the spine is the best way to diagnose retrolisthesis. If your X-ray is taken when you’re lying down, your doctor won’t be able to see retrolisthesis. An X-ray or other imaging study can reveal retrolisthesis.

The X-rays of the patient will then be evaluated by the doctor, who will measure the amount of slippage between the vertebral discs. They’ll trace several lines through the image of the vertebra and calculate the distance between them. A distance of two millimeters or more between the vertebra is a sign of retrolisthesis.

Retrolisthesis Treatment

The aim of retrolisthesis treatment is to reduce inflammation and pain. The treatment methods vary depending on the severity of the disorder and the extent to which the other tissues and discs are affected. Based on the results of your neurological exam and review of symptoms, your doctor may either recommend non-surgical treatments or surgery. Mild retrolisthesis can be treated with with non-invasive methods whereas surgery is a must for severe retrolisthesis.

Non-Surgical Treatments

• Pain medications such as non-steroidal anti-inflammatory drugs (NSAIDs) to relieve back pain and lower the swelling
• Microcurrent therapy that uses low-level electric currents to relieve swelling, discomfort, and inflammation
• Spinal injections
• Physical therapy to strengthen core muscles, back and spine
• Muscle relaxant medications
• Applying heat to the affected region
• Massages that help with muscle tone and improve circulation

Nutrition

If you have retrolisthesis, speak to your doctor about how you can improve your nutritional intake. Eating nutritional food will assist the body to heal naturally and improve bone and joint health over time. It’s a good idea to consult a dietitian to figure out what levels of each nutrient are suitable for your health. A good diet can also help in weight loss. Losing weight will help relieve pressure on your vertebra. Some of the nutrients and foods that you should include in your diet are:

1. Plant based proteins:

The proteins present in some plants are beneficial for the health of your spine. You should include plant-based proteins in your diet as much as possible. Animal-based proteins can cause inflammation.

2. Vegetables:

Certain vegetables contain properties that help against spinal problems. Broccoli, kale, spinach act well against inflammation. Each of these vegetables also contain nutrients that support spine health.

3. Dairy Products

Calcium is essential for maintaining and improving bone health. You should choose those dairy products that have a high calcium content. This category includes cheese, yoghurt and milk.

4. Herbs and Spices

Many herbs and spices are beneficial to the health of the spine. Turmeric, an Indian spice widely used in curry dishes, aids in the repair of damaged tissue. There are certain herbs that fight inflammation as well, such as basil, cinnamon, rosemary, and ginger.

5. Salmon

You can add salmon to your diet on a daily basis. Salmon is a good source of lean protein as well as omega-3 fatty acids, which are beneficial to your health. Omega-3 fatty acids are great for the bones and tissues. They, like the leafy green vegetables mentioned earlier, help to reduce inflammation.

Exercises and Physical Therapy for Retrolisthesis

Your doctor will refer a physical therapist who will teach you techniques on how to lift, move and sit properly. Exercise and physical therapy can help improve your mobility, flexibility, strength and also relieve leg pain and back pain. Walking, yoga and Pilates are examples of workouts that target the right areas. There are a variety of exercises you can do at home, like:

• Hip extensions
• Lower back rolls
• Sitting pelvic tilts on a ball
• Ab crunches

Effects of Exercises on Retrolisthesis:

They improve bone, muscle and ligament strength, improve nutrition to joint cartilage, including the intervertebral disc, improve the oxidizing ability of the skeletal muscles and improve neuro-motor control and coordination. In addition to this, exercise also raises the amount of endorphin in the cerebrospinal fluid and blood, which is shown to be reduced in patients with back pain. It also encourages a sense of well-being by increasing alpha wave activity, resulting in central and peripheral relaxation and a reduction in muscle tension.

Therapeutic Lifestyle Changes:

The importance of patient education about the condition and a list of precautions cannot be overlooked. Changes in activities and postures affect intradiscal pressure. Assessment of patient function is highly important during physical therapy sessions. Correct bending and lifting techniques should be taught. For acute disc lesions, sitting with the hips, knees flexed, or leaning forward should be avoided. Instead, the lumbar spine should be supported with the trunk inclined at 120° , since this provides the least load on the disc. To treat this condition, the patient is also taught to sit leaning back, with a wide support base. It is also recommended that you use a raised toilet seat.

Retrolisthesis Surgery

Spine surgery is only needed when nonsurgical treatments are not effective. Before recommending surgery, the orthopedists and doctor will determine the risk of long-term spinal and neurological damage. Your primary care physician will explain why spine surgery is important, as well as the surgical objectives and techniques. For example, a progressive or high-grade retrolisthesis might require spinal fusion and instrumentation for spinal stabilization to prevent the disorder from worsening. If left untreated, retrolisthesis can cause other complications like spinal stenosis, which may require surgical decompression (for example, a laminectomy) to relieve nerve impingement.

Spine Surgery and Retrolisthesis

In a 2007 report published in Spine Journal, researchers examined 125 patients who had an L5-S1 discectomy. They wanted to see if there was any retrolisthesis. They discovered that nearly a quarter of the patients in the study had L5-S1 retrolisthesis. The researchers also looked at the changes in spinal structures that occur as a result of degenerative retrolisthesis. Overall, they discovered that retrolisthesis was not associated with a higher incidence of degenerative disc disease or degenerative changes in the bony ring in the back of the vertebra.

Surgery may cause retrolisthesis. Another research published in 2013 in the Spine Journal showed that 4 years after a discectomy, pain from retrolisthesis either appeared for the first time or worsened. The same may be said for physical functioning.

Yet another research published in the Journal of Neurosurgery: Spine in December 2015 found that surgery might not be suitable for any patient with more than 7.2% retrolisthesis while in extension (back arching). The explanation for this was that in these cases, retrolisthesis increased the risk of lumbar disc herniation after surgery.

How can you prevent Retrolisthesis?

It is not always possible to prevent retrolisthesis. For instance, as a result of an injury, a person’s back can slip out of alignment. In other individuals, retrolisthesis can occur as a result of genetic factors. However, there are some steps and tips that you can take to minimize your risk. They are as follows:

• Maintain a proper posture while sitting or standing.
• Practice yoga, it will help you in many ways, like strengthening your core, back alignment, and improving your posture.
• Practice pelvic tilt exercises to strengthen your core muscles. A strong core reduces the pressure on your neck and back.
• Eat a nutritional and balanced diet for improved bone health and reduced back pain.
• Avoid hyperextension and placing too much weight on your back as these can strain your back and neck.
• Avoid smoking and tobacco intake as it can lead to joint damage.

Bottom Line

In conclusion, people can avoid retrolisthesis by exercising regularly, eating a healthy diet, and avoiding activities which might cause injury. Following the doctor’s advice and guidance is the most important factor in maintaining your quality of life with retrolisthesis. Staying healthy, consuming a nutritious diet, and taking steps to avoid spinal injury will all go a long way towards managing and treating this disorder.