By Kim Sang-hyuk There are many reasons for spine pain, but people commonly associate it with a herniated disc when there is a problem in their spine. But spondylolisthesis is one of those diseases that people are much less familiar with.According to Health Insurance Review and Assessment Service Agency, the number of patients with spondylolisthesis has increased from 13,000 in 2010 to 15,000 in 2013. Considering this condition accounts for 15% of the entire spinal surgery cases, it is one of the more frequent diseases in the spine. Spondylolisthesis is the forward displacement of a vertebra, causing pressure on spinal nerves. Our spine consists of multiple vertebrae that are connected to support the body weight and to allow the body movement.However, if the connections between these become loose and dislocated, the upper vertebra moves forward over a lower one and presses on spinal nerves, causing back pain and leg numbness.In 1782, Belgian gynecologist found out that the forward displacement of the fifth lumbar vertebra compresses the pelvis causing various problems when giving birth.Although spondylolisthesis was first found in an abnormal way, it has been studied for a very long time. Progression of spondylosis or degenerative changes There are many causes of spondylolisthesis, but there are two main reasons; progression of spondylosis and degenerative changes.A spondylosis refers to defect in a vertebra due to a fracture. Along with innate reasons, spondylosis is caused by excessive exercise or trauma to the spine.Spondylosis can lead to intermittent back pain depending on the position, but the symptoms may not appear. Thus, there are many cases where people live without knowing the fact that they have spondylosis.However, once the spondylosis progresses to move the vertebra forward, it develops into spondylolisthesis and causes spinal pain. Furthermore, degenerative changes may loosen the connection between the vertebrae causing the displacement.Also, spine muscles and ligaments which provide firm support to the spine may loosen to destabilize the spine and distort the disc between vertebrae, ultimately causing the spondylolisthesis.In addition to the reasons mentioned above, complications from spine surgery or slow growth in adolescence can be other reasons. Exercise in early stages, surgical method if it worsens If in the early stage where the spondylosis has not yet progressed into spondylolisthesis, spine muscle strengthening exercises can be very effective. Light walking, swimming or manual therapy can be helpful in improving the pain and leg numbness.If the patient is overweight, then losing weight is recommended as it can decrease the weight on the spine. MEDX treatment can also be effective as it accurately measures the level of spine muscle strength and monitors the improved muscle strength. If the symptoms persist even after the conservative treatment, then surgical treatment such as spinal fusion surgery should be considered. Previously spinal fusion surgery involved a large incision of 15 to 20 centimeters to fixate the spine.However, minimally invasive surgery technique has developed to minimize various risks associated with the surgery. Performed with the microscope, the minimally invasive technique has benefits of minimizing the damage to surrounding tissue and blood loss, ultimately decreasing a chance of post-surgical complications. The writer is director of the spine center at Bumin Hospital Seoul in Gangseo District. He was named in the 2014 edition of Marquis Who's Who..