Spondylolisthesis is a deformity of the spine that involves the dislocation of the vertebrae. Those that lie higher tend to move forward of those that are below. There are two main groups of patients suffering from this disease - people up to 50 years of age and the elderly. The disease has different characteristics in each of these groups.

Spondylolisthesis is a serious condition of the spine that can be easily mistaken for a discopathy or sciatica. If you suspect its occurrence, you should immediately see a specialist, because the disease may progress and lead to irreversible consequences.

Spondylolisthesis - causes

Spondylolisthesis can have various causes, but two of them are by far the most popular. The first - which is more common in young people - concerns the so-calledvertebral arch fissures , i.e. places where the upper and lower articular processes connect (most oftenin the area of ​​the lumbosacral transitionin the lower section of the lumbar spine L5- S1 and L4-L5). One of the elements of the spine (most often the vertebral arch) is damaged, the continuity of the bones is broken. The spine becomes a little more mobile in this area, losing its stability. And this state may progress over time.

On the other hand, in the elderly, spondylolisthesis most often arises as a result of degenerative disease of those parts of the spine that were responsible for the stabilization of the vertebrae. When they wear out as a result of an illness and are no longer able to fully perform their functions, it is often the spondylolisthesis that occurs.

Spondylolisthesis can also arise as a result of:

  • direct spinal injury, e.g. falling ( traumatic ),
  • be a congenital defect of vertebral joints and arches ( dysplastic substrate ),
  • tears of the vertebral arch, i.e. spondylolysis ( nodal ),
  • degenerative changes in the spine ( pathological ),
  • interruptions of the interarticular part of the vertebral arch ( istmic type ), i.e. fatigue fracture.

Spondylolisthesis - symptoms

The symptoms of spondylolisthesis may not be obvious at first asthe disease usually progresses slowly . In the initial stage, the spondylolisthesiscauses leg fatigueandlower back pain , which radiate to the lower limbs . They are especially intensified when getting up and sitting down. Other characteristic symptoms that may be evidence of this condition are:

  • deformation of the lumbar region,
  • muscle atrophy,
  • sensory disturbance,
  • weaker reflexes.

When spondylolisthesis is suspected, see a specialist immediately. Especially when the patient notices more advanced symptoms, e.g. when the pain in the lower limbs intensifies not only in movement, but also returns after rest. In the later stages of the disease, problems with movement, paresis and problems with incontinence appear.

Spondylolisthesis - degree of advancement

To identify the severity of the disease, the Meyerding classification is used, which determines how much the vertebrae are shifted relative to each other:

  • offset less than 25 percent -first degree ;
  • shift between 25 and 50 percent -2nd degree ;
  • shift 50-75 percent -3rd degree ;
  • offset over 75 percent -fourth degree ;

The final stage is the loss of vertebral contact, i.e. total spondylolisthesis.

Spondylolisthesis - treatment

The methods of treating spondylolisthesis depend on the stage of the disease, its type and the patient's age. Choosing a treatment method requires an appropriate diagnosis. In order to carry it out, imaging examinations are performed: X-ray, magnetic resonance imaging, computed tomography.

In the initial stage of the disease, the most common isconservative treatment , which consists inimmobilizing the patient and administering medications . The medications given to the patient are supposed to reduce pain, relax the muscles and have anti-inflammatory properties. This type of treatment may last up to three months. After the pain has subsided, the patient wears an orthopedic shoelace and performs exercises recommended by a physiotherapist. The patient, by exercising together with a specialist,works on the correct muscle tone, the trunk system and prevents secondary changes .

Another treatment option is the use of percutaneous transpedicular stabilization, i.e. a minimally invasive method of laser disc compression.

However, if conservative treatment is not effective and the pain persists or the patient reports to the doctor in the second or higher stage of the disease, it is necessary tosurgical treatment , which consists in complete removal spondylolisthesis. The type of treatment is selected individually. Possible treatments include :

  • local stabilization,
  • node reconstruction,
  • vertebral spondylosis (only for small spondylolisthesis)
  • reposition and stabilization of the vertebrae
  • vertebrectomy of the L5 vertebra (anterior excision of the vertebra with simultaneous L4 / S1 anastomosis).

Category:

Anatomy