The bone and ligamentous apparatus of the spinal column is designed in such a way as to create stability of the spine. An injury or defect within the structures of the lumbar spine can be a source of low back pain. A slit-like defect in the interarticular part of the vertebral arch is called spondylolysis . If the fissure occurs on both sides of the vertebral arch, the spine is able to slip forward, a condition called spondylolisthesis . These diseases occur in about 5-6% of people.
There are five main types of lumbar spondylolisthesis:
1. Dysplastic spondylolisthesis. Dysplastic spondylolisthesis develops when there is a defect (malformation) in a vertebra that allows the vertebra to move forward. This is a congenital disease.
2. Isthmic spondylolisthesis (Spondylolysis). In isthmic spondylolisthesis, a defect occurs in a part of the vertebra called the interarticular surface. If the identified defect exists without displacement, the patient’s diagnosis is spondylolysis. Isthmic spondylolisthesis can be caused by repeated trauma and is common among athletes who perform overstretching movements (gymnasts, rugby players, and other similar sports).
3. Degenerative spondylolisthesis. Degenerative spondylolisthesis develops due to arthritic changes in the joints of the vertebrae due to cartilage degeneration. It is common among older patients.
4. Traumatic spondylolisthesis. Traumatic spondylolisthesis occurs due to direct trauma or damage to the vertebrae. This disease can be caused by a fracture of the pedicle, lamina of the vertebral arch, or facet joint, which causes the front of the vertebra to move forward relative to the back of the vertebra.
5. Pathological spondylolisthesis. The cause of pathological spondylolisthesis is a defect in the bone caused by a tumor.
The most common symptom of spondylolisthesis is pain in the lower back. It intensifies after exercise, especially when stretching the lumbar spine. Other symptoms include hamstring tightness and decreased range of motion in the lower back. Some patients may experience pain, numbness, tingling, or weakness in the legs due to nerve compression. Severe pressure on the nerves can cause loss of bowel or bladder control or cauda equina syndrome.
In most cases, when examining a patient, it is unbelievable to reveal signs of spondylolisthesis. Patients traditionally complain of back pain and occasional pain in the legs. Spondylolisthesis often causes muscle spasms or hamstring tightness.
Spondylolisthesis is easily detected using plain radiographs. A lateral radiograph will show if one of the vertebrae has moved forward in relation to the adjacent vertebra. Spondylolisthesis is divided into degrees depending on the percentage of displacement of the vertebra in relation to the adjacent vertebra.
Grade I – displacement up to 25%.
Grade II – bias from 26% to 50%.
Grade III – bias from 51% to 75%.
Grade IV – bias from 76% to 100%.
Grade V develops when a vertebra completely separates from an adjacent vertebra (spondyloptosis).
Treatment of spondylolisthesis begins with conservative methods:
- A short period of rest or avoiding activities such as weight lifting and bending over, as well as playing sports, can relieve symptoms of spondylolisthesis.
- Physiotherapy helps to reduce the range of motion of the lumbar spine and hamstrings, as well as strengthen the abdominal muscles.
- Anti-inflammatory drug products reduce pain by reducing inflammation in the muscles and nerves.
- Patients suffering from pain, numbness, and tingling can relieve these symptoms with an epidural injection of a steroid (cortisone).
- Patients suffering from isthmic spondylolisthesis wear a brace to prevent overstretching. It fixes the lumbar spine, pulling together two parts of the bone at the site of the defect, which facilitates the healing process.
For those patients who have not been helped by conservative treatment, surgery is offered. The type of operation is selected depending on the type of spondylolisthesis.
According to the site www.neurosurgery.com.ua