Dawn Limbert: 'Vertebral slippage due to injury is rare, but can be very serious'

THE injury to Thom Evans in the Six Nations involved the slippage to one vertebra in the cervical spine. This is a common term for spondylolisthesis.

In this condition, one or more vertebrae usually move forward and out of alignment with the remainder of the vertebrae.

The condition most commonly occurs in the lower lumbar region, but can occur anywhere in the spine.

Vertebral slippage due to injury is rare, but can be very serious. When the slippage is severe, the vertebrae can almost, or completely, detach from each other, compressing the spinal cord or spinal nerves, with neck pain and/or limb pain being the most common symptom.

Patients normally require surgery involving fusion of the vertebrae. Spinal fusion involves removing the degenerated disc material and fusing – or joining together – the vertebrae on either side of the disc space using either a graft, a piece of metal or a cage.

This requires a small piece of bone material to help promote bone growth at the fusion site. Ossification of the fusion site normally takes 12 weeks.

Patients with this type of surgery can be expected to be in hospital for two to three days. After discharge from hospital, patients are normally evaluated monthly for the first six months, and then once every three months thereafter.

In the case of Thom Evans, he will be evaluated on a much more regular basis in order to return to full fitness. The primary form of rehabilitation after surgery is an aggressive walking programme, which normally starts immediately after discharge.

The average patient can be walking 15 minutes twice a day by their first post-operative visit, and 30 to 40 minutes twice a day by six weeks after surgery.

• Dawn Limbert is an osteopath and sports injury specialist. She is a lecturer at the London School of Osteopathy.