Counsel That You Can Trust & Depend On


Guy DiMartino
Nov. 4, 2014

Michigan City Indiana lawyer and chiropractic physician discusses surgery for spondylolisthesis after an accident.

Over the years, I have seen many folks injured in car accidents and slip and falls learn that they had an underlying spondylolisthesis after the accident. The story is always the same, the client had no real history of back pain and didn't even know that the condition existed. After the accident, the client developed back pain that doesn't respond to conservative treatment. Eventually, an orthopedic or neurological surgeon recommends a procedure to stabilize the area. It never fails, the insurance adjuster then takes the position that the accident didn't cause the client's complaint, it was the underlying spondylo.

What is spondylolisthesis

For this discussion, I'm going to focus on the lower back where we see a majority of these conditions. Spondylolisthesis is a forward slippage of one vertebrae on another. This is a side view of an x-ray showing slippage of L4 on L5.

There are a number of causes of spondylo, however, I'm going to discuss the three most common (1) isthmic (2) congenital and (3) degenerative. Isthmic occurs when part of the lumbar vertebrae called the pars interarticularis has a defect. It is thought to be caused by excessive back bending in sports like gymnastics. Congenital spondylo happens when there is a defect in the formation of a part of the vertebrae which impacts the pars. Degenerative spondylo can happen when a person ages and the pars fractures allowing the vertebrae to slip forward.

The most common classification system for spondyloslisthesis is Myerding's. It rates the slippage by a percentage. Class I is up 25% percentage slippage and it runs through Grade V, which is 100% slippage or greater.

Non-Surgical Treatment

When I was in practice, I successfully treated patients with spondylolisthesis with non-surgical means. This included spinal manipulation, physical therapy and stabilization exercises.

Surgical Treatment

If the spondylolisthesis becomes unstable or is pushing on nerve roots and causing a condition called radiculopathy, surgery may be indicated. A recent article in the Journal of Bone & Joint Surgery discussed the costs and complications associated with the different types of surgical procedures for this condition. According to the researchers, decompressive laminectomy (removal of a part of the vertebrae) and fusion were associated with lower reoperation rates and higher complication rates than laminectomy alone. The authors concluded that the patient and the doctors should evaluate the clinical effectiveness and costs to determine the appropriate procedure.

Take Home

Over the years, I have seen patients and clients undergo surgery for spondylolisthesis. Most had a complicated post-surgical course with residual pain and dysfunction. These issues have to be looked at when deciding whether to undergo operative versus non-operative care following an accidental injury.

If you have any questions about lower back pain after an accident, you can call our Michigan City personal injury lawyer at (219) 874-4878. Meeting you at the intersection of law & medicine!