Lumbar spondylolisthesis is the displacement of the lumbar vertebrae in either the forward or backward position. It can cause pain, numbness, and tingling in the lower back, buttocks, or thighs, making walking or standing up straight difficult.
In Western medicine, surgery may be recommended when lumbar traction does not bring relief.
In traditional Chinese medicine (TCM), treatment from acupuncture, herbal medicine, tuina (a manipulative therapy), and massage are also unable to cure it completely.
Is lumbar traction effective for lumbar spondylolisthesis? What are the sequelae (secondary results) of surgery? What are the causes, symptoms, and ways to prevent it?
About 4–6 percent of the U.S. population suffers from lumbar spondylolisthesis, but only a small number of them will develop symptoms or require surgery.
How Effective Is Lumbar Traction?
According to statistical data from my outpatients with lumbar spondylolisthesis, around 4 in 5 of their Western physicians recommended stretching their lumbar vertebrae to improve their symptoms, while the other 1 in 5, usually the more experienced physicians, did not recommend stretching their lumbar vertebrae.Sequelae of Lumbar Surgery
Surgery has certain benefits but is not consistently successful in treating lumbar spondylolisthesis. A study in Japan analyzed 100 patients with spondylolisthesis, then followed them for an average of 3.7 years. The study found that 73 percent of the patients improved significantly after surgery, 12 percent did not show significant improvement, and 13 percent experienced some improvement immediately after surgery but worsened later.Potential Sequelae of Lumbar Surgery
1. Recurrence of Slippage
In terms of the natural soft curvature of the entire spine, when the misaligned anterior and posterior portions of the upper and lower vertebrae are nailed with steel pins, the localized vertebral body loses freedom of natural movement. Compared with the upper vertebral body, it is rigid, while the movement of the upper vertebral body remains relatively soft, creating a soft upper portion connected with a rigid one below.With long-term natural movement and degeneration of the vertebrae in this condition, there is a chance the patient may develop symptoms of spondylolisthesis or disc herniation in the vertebrae within 5 to 10 years, resulting in severe pain in the lower back and the leg.
2. Unable to Recover Naturally
Once steel pins are planted, many rehabilitation routines that are effective in pain relief will no longer be applicable. When pain is not relieved after surgery, or the sequelae become apparent a few years later, further treatment becomes more difficult.Who Is Fit for Surgery?
For those who are suffering from severe lumbar spondylolisthesis—level 2 or above in severity—where there are problems with urination and moving the bowels, as well as apparent symptoms of severe weakness in their lower limbs, surgery could be considered for pain relief.
Lumbar spondylolisthesis is graded according to the relative percentage displacement between the upper and lower vertebral proper.
- First-degree spondylolisthesis is from 0 ~ 25 percent
- Second-degree spondylolisthesis is between 25 ~49 percent
- Third-degree spondylolisthesis is from 50 ~ 74 percent
- Fourth-degree spondylolisthesis is between 75 ~100 percent
- Fifth-degree spondylolisthesis is when the upper vertebrae slip forward onto the vertebra below it.
Causes of Lumbar Spondylolisthesis
1. Poor Sedentary Posture
Improper posture is the main reason the lumbar spine slips, eventually causing compression and slippage.2. Wrong Application of Force
Lifting or exercising in improper positions may result in lumbar spine slips. Spondylolisthesis may also be due to physical injuries resulting from falling.3. Overweight
Being overweight creates a consistent pull on the front of the body, resulting in uneven stress on the spine.4. Kidney Deficiency
Some people have a body constitution of what TCM calls “kidney deficiency.” Those with kidney deficiency usually have weaker muscles around the lumbar spine that are unable to provide necessary support, causing instability. In this context, “kidney deficiency” does not mean just poor kidney function but describes the larger energy system around the kidneys, which includes the bones and spine. People with kidney deficiency are prone to symptoms such as lower back pain and osteoporosis.Symptoms of Lumbar Spondylolisthesis
Lumbar spondylolisthesis is by far the main reason for lumbar nerve compression causing sciatica. Its common symptoms are the feeling of tight ligaments around the extensive muscle mass encompassing the sacrum, buttocks, and even the back of the thighs. This is because our muscles are wrapped with a layer of fascia that links the upper and lower parts of the body, and any backward slippage of the lumbar spine will cause tension. This will grasp the fascia and squeeze the nerves, resulting in tight muscles and ligaments. In some cases, the patient may experience severe pain and be unable to walk. In more serious cases, they may even experience urinary and fecal incontinence—by then, the degree of slippage is severe.Ways to Prevent Lumbar Spondylolisthesis
1. Proper Sedentary Posture
Maintaining a proper sedentary posture is vital in preventing lumbar spondylolisthesis. I prefer to sit only on the front third of the chair, keep the body upright, and never lean on the back of the chair.Some might have lower back aches while sitting upright, which could indicate that the original curvature of the lumbar spine has disappeared and is becoming stiff. In TCM theory, the Du meridian is an important energy channel that runs through the spine. People with a straight spine will feel the fullness of energy while sitting up straight because that is when the Du meridian flows easily.
2. Less Sofa Sitting
Sit less on sofas and more on hard chairs instead. In this way, the spine will be trained to become more upright by itself.3. Proper Posture While Lifting
The key to lifting heavy objects is to keep your back straight, then squat down with your thighs—like a weightlifter.4. Muscle Training and Kidney Nourishing
For people with kidney deficiency, it is likely their psoas muscle system is not that strong. Exercise can foster their muscles and bones and strengthen their ligaments. Consulting with a TCM expert for kidney-tonifying and muscle-strengthening medicine is also an option.Summary
The above information is based on my clinical practice and observations over a number of years. In the following article, I will introduce ways to improve the symptoms of lumbar spondylolisthesis through simple self-rehabilitation routines to avoid surgery and medication.Views expressed in this article are the opinions of the author and do not necessarily reflect the views of The Epoch Times. Epoch Health welcomes professional discussion and friendly debate. To submit an opinion piece, please follow these guidelines and submit through our form here.
