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Spondylolisthesis is a spinal disorder where a vertebra (disk of bone) in the lower spine cracks and then slips forward and onto a bone below it, creating a painful condition that eventually requires surgery.

Surgery used after conservative therapies fail

Spinal fusion surgery is used to treat spinal disorders such as spondylolisthesis, scoliosis (abnormally curved spine) or spinal fractures. As treatment is prescribed according to the condition of each patient, surgery is not always necessary, and is used as a last resort after conservative therapies have failed. However, it is commonly performed as other treatments such as medication, physiotherapy and acupuncture work only to relieve pain and discomfort and do not cure the underlying condition. This results in many people suffering from recurrent bouts of pain due to progression of the spinal disorder.

According to Clinical Associate Professor Tan Seang Beng, Senior Consultant and Director of the Spine Service at the Department of Orthopaedic Surgery at Singapore General Hospital (SGH), a member of the SingHealth group, SGH has been using spinal fusion with bone morphogenetic proteins (BMPs) since mid-2008, and the results have been very encouraging.

"BMP can be expensive (spinal fusion with BMP can cost approximately S$40,000) but for many patients, the benefits far outweigh the cost. “It's like building a house, so you have to consider how strong a foundation you desire. Spinal fusion repairs the crack by fusing two or more vertebrae while BMP aids in the formation of new bone," said Dr Tan.

"So while no surgery is 100 per cent successful because ultimately the ability to heal depends on the patient’s own body, the chances and speed of recovery are theoretically better than having only conventional spinal fusion surgery. Of course, any outcome also depends on your condition, bone quality and age. Not everyone goes through the same level of pain such that it affects one’s daily life. So the crux is to determine if you are prepared to tweak or give up your current lifestyle and live with occasional pain, " explained Dr Tan.

Rehabilitation after surgery

For Mr Yeo, the decision to proceed with surgery took half a year. He could either take a chance with surgery, or not, in which case he would have to give up sports and change his lifestyle. During this time, he managed to continue with his daily life, but still felt the effects of his condition. Said Mr Yeo: "On some days, my back would ache so badly that I couldn’t walk for more than 30 minutes in a shopping mall without having to rest."

After the surgery, he was put on a rehabilitation programme, where he was taught exercises to help strengthen his core muscles. To allow his body to recover slowly, he took his time in returning to his favourite sporting activities. Within half a year, he was able to swim. This was followed by jogging, wakeboarding and tennis. Mr Yeo now enjoys these activities at least once a week, just like he did pre-surgery, and is even planning to compete in a marathon at the end of the year. More importantly, he has gained a new confidence in his physical fitness. "My back is the strongest part of my body now," he said.

About spondylolisthesis in Singapore

Five per cent of Singaporeans are estimated to have spondylolisthesis. Most patients diagnosed with it, however, are not even aware they have the condition. In fact, many mistake it for common backache. "Initially, the pain is like that of a sprained back. The only difference is that while the pain from a sprained back will go away with treatment, the pain caused by spondylolisthesis stays. By the time a patient comes to us, he or she would have been in pain for many months or even years," said Dr Tan.

Causes of spondylolisthesis

According to Dr Tan, the causes of spondylolisthesis depend on its nature. The different types of spondylolisthesis are:

  • Degenerative spondylolisthesis

    • When ageing causes cartilage and vertebra quality to deteroriate.
    • This is common in 60 per cent of Dr Tan’s patients, aged 40-60 years and above.

  • Isthmic spondylolisthesis

    • When a fracture in the bone occurs due to stress.
    • It is especially common in athletes exposed to hyper-extension motions or excessive loading in sports such as gymnastics, weight-lifting and contact sports.
    • This group, aged mostly between 20 and 30 years, accounts for up to 30 per cent of Dr Tan’s patients.

  • Other types of spondylolisthesis

    • Dysplastic (birth defect), Traumatic (acute injury) and Pathologic (cancer). 
    • These collectively account for 10 per cent of Dr Tan’s cases, including a four-year-old patient, the youngest he has ever operated on.

Ref: W09