Spondylolisthesis is an abnormal shift of the vertebrae in relation to each other - the higher vertebrae slides forward or backward relative to the lower vertebrae. Spondylolisthesis is associated with the instability of the spine - the greater the slide of the vertebrae, the greater the degree of instability. Spondylolisthesis most often occurs in the lumbar and lumbosacral spine, usually at the L5 / S1 level. Minor spondylolisthesis do not always cause pain. More dislocation of the vertebrae may result in pain, deterioration of efficiency and the appearance of neurological symptoms.
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Types of spondylolisthesis
Anterior spondylolisthesis (anteriolysthesis) and posterior spondylolisthesis (retrolisthesis)
The anterior spine consists of "sliding" to the front of the upper vertebra together with the higher section of the spine in relation to the lower vertebra. The displacement of the spine column may (but does not have to) be accompanied by damage to the bone structures and pressure on the nerve roots.
In the course of the posterior spondylolisthesis, the vertebrae shifts back along with the higher spine. The most common causes are degenerative changes, shallowing of lumbar lordosis and destructive changes caused by inflammatory diseases of the musculoskeletal system.
Pseudo-spondylolisthesis
The pseudo spondylolisthesis continues without breaking the vertebral arch. The formation of pseudo-spondylolisthesis is most often due to the degeneration of the intervertebral disc and degenerative changes in the intervertebral joints at the same level. In the course of pseudo-spondylolisthesis, stiffening and deepening of thoracic kyphosis and limited extension in the hip joints are often observed. "Stiffening" of the adjacent body segments forces compensatory excessive mobility in the lumbar spine. The problem is aggravated by obesity, a sedentary lifestyle and the poor ability of the deep muscles to inhibit the translational movements of the vertebrae. An inactive or too late activated multisection muscle of the spine does not stiffen the columns of the spine effectively, leading to repeated uncontrolled movements in sliding of the vertebrae and the development of instability. Of great importance for the prophylaxis of spondylolisthesis is the training of muscles stabilizing the lumbar spine and learning the correct body mechanics during everyday activities and work.
True spondylolisthesis
The true spondylolisthesis is interrupted by the discontinuity of the vertebral arch. It develops on the so-called spondylolysis (vertebral fissures), i.e. fractures in the interarticular part of the vertebral arch. Spondylolysis may result from the accumulation of overload of the spine or it may arise as a result of a high-energy injury (e.g. during a traffic accident).
In the course of a true spine, the body, the anterior part of the arch, transverse processes and superior articular processes of the vertebra are displaced, along with the spine located higher than the site of the spondylolisthesis. The spinous process, the posterior articular processes, and the posterior part of the arch remain in place.
Dysplastic spondylolisthesis
The cause of dysplastic spondylolisthesis is a congenital abnormal structure of the inter-process joints and / or an abnormal shape of the vertebral arch. This type of spondylolisthesis is usually diagnosed in children.
Symptoms of spondylolisthesis
In the early stages of spondylolisthesis, no disturbing symptoms are often observed, as the vertebrae shifts so slowly that the nerve roots have time to adapt. Pain is released as a result of an enlarged slide that exceeds the ability of the nerves to stretch. Acute pain occurs when a traumatic spondylolisthesis occurs.
Symptoms of advanced-stage spondylolisthesis include:
pain in the lumbar spine, which may radiate to the legs,
deformation of the lumbar region - a fault in the line of the spinous processes,
incorrect position of the pelvis,
limitation of the mobility of the spine,
sensory disturbances, paresis and weakened muscle reflexes in the lower extremities.
Physical activity and physical work most often aggravate the symptoms. If symptoms reappear after a rest period, consultation with a neurosurgeon is advisable.
Spondylolisthesis - diagnosis
In addition to the clinical symptoms, the doctor assesses X-rays of the spine. It is important that the X-ray is taken in a standing position. The degree of vertebral slide is determined by evaluating the percentage ratio of the vertebra displacement to the width of this vertebra:
I: less than 25%
II: 25% - 50%
III: 50% - 75%
IV: above 75%
If there are neurological symptoms, an MRI of the spine is performed.
Spondylolisthesis - treatment
Conservative treatment
Conservative treatment is carried out in the first degree and in selected cases of the second degree of spondylolisthesis. Management consists of rest and the administration of painkillers and anti-inflammatory drugs. After the acute condition subsides, the patient should participate in the rehabilitation process, which will improve the muscular stabilization of the spine. It is also extremely important to learn how to perform everyday activities in a safe way. Occasionally, your doctor may recommend that you wear a corset or a spine stabilizing belt. Control of the staging of the spondylolisthesis on X-rays is carried out every 6-12 months or on dates individually set by the doctor.
Surgery
The indications for surgical treatment are:
- persistence of pain despite rehabilitation (1st or 2nd degree),
- progression of the degree of spondylolisthesis, worsening of pain symptoms,
- the occurrence of neurological symptoms in the form of muscle paresis in the lower limb and / or urinary incontinence,
- 3rd and 4th degree of spondylolisthesis.
The surgical procedure consists in decompression of the compressed nerve structures by reposition of the slipped vertebra and its stabilization. For this purpose, the surgeon uses special implants that stiffen the selected section of the spine.
Sources:
Wójcik Gustaw. Epidemiology and classification of lumbosacral spondylolisthesis – part II. Journal of Education, Health and Sport. 2017;7(8):367-377.
Frequently asked questions about spondylolisthesis:
The degenerative spine consists in the sliding of the vertebra along with the higher section of the spine in relation to the lower vertebrae. The most common is the formation of anterior spondylolisthesis in the lumbosacral section of the spine - the last lumbar vertebra slides forward relative to the first sacral vertebra. The causes of degenerative spondylolisthesis are degenerative changes in the intervertebral disc and intervertebral joints. Symptoms of spondylolisthesis increase with the degree of skidding - from slight discomfort in the lumbar region and limited mobility to the appearance of neurological symptoms resulting from compression of nerve structures (sensory disturbances, weakening of the muscles of the lower extremities).
The procedure depends on the severity of the spondylolisthesis. Slight shifts (1st and 2nd degree) are rehabilitated. Painkillers and anti-inflammatory drugs are used as supportive measures. In the event of unsuccessful rehabilitation, further progression of the spondylolisthesis, the appearance of paresis or urinary incontinence, as well as third and fourth degree spondylolisthesis, the doctor will qualify for surgical treatment. The aim of the procedure is to decompress the nerve structures and to stabilize the retracted vertebra with implants in the corrected position.
