spondylolisthesis

Spondylolisthesis: description

When a vertebra slips out of its true position, the doctor talks about a spondylolisthesis or spondylolisthesis. Such a so-called sliding vertebra may move forward relative to the other vertebrae (ventral spondylolisthesis) and posteriorly (dorsal spondylolisthesis).

Spine – structure and function

The spine carries the weight of the body and transfers it to the legs. It consists of 33 vertebral bodies and 23 intervertebral discs. Some vertebrae are fused together. A strong muscular and ligamentous apparatus strengthens the spine.

Two vertebrae form together with the intervening intervertebral disc a so-called motion segment. They are connected by ligaments, muscles and joints. If these connections are weakened, the vertebra may slip forward or backward. Most of the affected vertebrae are located in the lumbar area. Since the lowest lumbar vertebra is firmly connected to the pelvis, spondylolisthesis mainly affects the penultimate lumbar vertebrae (L4).

According to the German Society of Orthopedics and Orthopedic Surgery, two to four percent of Germans suffer from spondylolisthesis. By far the most common affected ethnic group are the Inuit. About 40 percent of them have sliding vertebrae. Outside of this ethnic group athletes whose spinal column is particularly affected by overstretching suffer from spondylolisthesis. These include, for example, javelin throwers or wrestlers. The most common sliding vertebra is the lowest lumbar vertebra, which lies directly above the sacrum (Os Sacrum).

Spondylolisthesis: symptoms

Spondylolisthesis may be without complaint. Other sufferers suffer from pain, especially under stress and during certain movements. The pain caused by spondylolisthesis can spread in a belt shape from back to front. There is also a sense of instability in the spine. Especially in the morning, when the back muscles are relaxed, the pain is strong. In severe cases, there are reflex, sensory and motor disturbances, which can also extend to the legs. These symptoms occur when the spinal fluid squeezes a nerve root through a spondylolisthesis.

However, there are no specific glideal symptoms as the symptoms may be similar to those of other back problems, such as herniated discs.

In the congenital form of spondylolisthesis sufferers usually have no or only mild symptoms, as it is a slow progressive process. So the nerves have the opportunity to adapt to the changed circumstances.

Spondylolisthesis: causes and risk factors

In order for the affected vertebra to slide forward, there must be a gap in the so-called interarticular portion. This is the area between the articular processes of the vertebrae up and down, which form a flexible connection between the vertebrae. If these joint connections are damaged, the vertebra is more mobile, can thus slip out of the spine axis – a Spondylolisthesis arises.

The most common cause of spondylolisthesis is wear-related (degenerative) damage to the vertebrae. This mainly affects the lumbar area. Over the course of life, the discs lose height due to fluid loss. As a result, the vertebral bodies approach, which disturbs the function of the ligament and muscle apparatus. In less well-trained people, the muscles can also compensate for disc damage worse. Then the vertebrae have even less grip.

A high load on the spine, combined with a strong overstretching to the rear, can lead to a Isthmian Spondylolisthesis lead. The risk sports include javelin throwing, artistic gymnastics, but also weightlifting.

Severe injuries (trauma) of the spine can significantly reduce the stability and thus lead to a spondylolisthesis.

In connection with certain diseases of the bone, such as the vitreous bone disease, a so-called pathological Spondylolisthesis occur. This is very rare.

Also after operations on the spine can occur as a complication spondylolisthesis.

However, spondylolisthesis sometimes does congenital Causes. This is especially the case with malformations (dysplasia, spondylolysis) of the vertebral arch. The triggers for this are almost always unclear. First-degree relatives of sufferers also have an increased risk of congenital malformation. In boys, this damage occurs three to four times more often than in girls. In girls, however, spondylolisthesis is usually more pronounced.

Spondylolisthesis also occurs in certain populations frequently, for example, the Inuit in Alaska.

Note: A so-called pseudospondylolisthesis causes similar symptoms as a spondylolisthesis. It is the slight forward or backward sliding of a vertebra due to disc wear.

Spondylolisthesis: examinations and diagnosis

If you suffer from severe back problems, you should first contact your family doctor. This will refer you to an orthopedist if you suspect a spinal disease, possibly a spondylolisthesis. However, if you have severe pain, severe motor or sensory disturbances, or problems with bowel movements or urination, you should seek medical attention immediately. However, spondylolisthesis is rarely an emergency. In most cases, the established orthopedist is the right specialist, who will ask questions such as:

• Are the pain dependent on exercise or exercise?
• Do you have sensory or motor disorders?
• Does your spine feel unstable?
• Do you do sports?
• Did you hurt yourself on the spine?
• Are there any similar complaints in your family?
• Were you already with other doctors because of your complaints?
• Have you tried any treatments for your condition?

Physical examination

After the interview, the physical examination follows. The doctor will pay attention to how the spine runs and how the patient moves and supports to gain insight into the nature of spinal problems. Obvious deformities of the spine, such as scoliosis, may be noticeable. This is understood by physicians an S-shaped course of the spine.

It is also possible that already when looking at the spinal column, a hump is visible in the course of the spine (hilltop phenomenon). The doctor can also find such steps by scanning the posterior appendages of the vertebrae (spinous processes). It also records the muscle status around the spine and defines the position of the pelvis. By tapping and pressing he identifies painful regions.

Functional test of the spine

This is followed by physical tests to check the function of the spine. This is among other things the Schober sign. The doctor marks a distance of ten centimeters from the highest coccygeal vertebra. The patient is then asked to maximally prevent themselves. The previously defined distance should increase by five centimeters. In a limited movement or excessive spine, the distance remains smaller.

Subsequently, the doctor can check the so-called compression pain. This pain occurs when the spine is compressed by slight pressure. The physical examination also includes examinations of the reflexes, sensibility and motor function. Which special examination will follow depends on the symptoms.

Imaging studies

For subsequent clarification, an X-ray image is taken from different directions (planes). In certain cases, it may be necessary to supplement these images with more specialized procedures, such as magnetic resonance imaging (MRI), in particular for evaluation of the intervertebral discs and compto-tomography (CT) for closer examination of the bones.

Further measures

In exceptional cases, a nuclear medicine examination (such as skeletal scintigraphy) may be necessary. Also in isolated cases, neurological electrophysiological examinations may be useful, for example if a nerve root is stimulated (possibly) by the spondylolistra- tion and the pain radiates.

If there is evidence that the patient is suffering from mental comorbidities (such as depression) or the pain becomes chronic, a visit to a psychotherapist may be appropriate.

Classification in degrees of severity

Spondylolisthesis is divided into different degrees of severity. This classification was made by Meyerding in 1932:

• Grade I: eddy gliding <25 percent
• Grade II: 25 to 50 percent
• Grade III: 51 to 75 percent
• Grade IV: 75 to 100 percent

If the vertebral gliding is more than 100 percent, the two neighboring vertebrae are out of contact with each other. Physicians then speak of a spondyloptosis. It is sometimes referred to as Grade V of the Severity Scale.

Spondylolisthesis: treatment

The main goal of the therapy is the improvement of the quality of life, in particular a reduction of the pain. This is achieved primarily by stabilizing the vortex. The vertebral glide therapy is based on two pillars, conservative and surgical treatment. While in mild cases counseling and conservative therapy usually suffice, inpatient treatment may be required as a second stage. Only in severe cases surgery is necessary.

Conservative therapy

At the beginning of a sliding vertebra therapy there is always a comprehensive consultation. In doing so, the patient learns how to specifically relieve his spine. Reducing the physical strain in private and professional settings, the symptoms can already improve significantly. Especially certain sports that strain the spine by frequent overstretching, must be avoided in a spondylolisthesis. Patients with increased body weight are advised to reduce their weight as part of spondylolisthesis therapy.

To get the pain under control, there are several pain medications to disposal. But also anti-inflammatory and muscle-relaxing drugs can help. Some of these drugs are injected locally in a spondylolisthesis in the painful regions.

physiotherapy in different form and intensity the pain should decrease. A strong musculature is a guarantee for a stable spine, counteracts the vertebral gliding. This is best achieved through gymnastics. As part of a back training, those affected learn strategies for training and dealing with the disease. Among other things, the patients learn favorable postures and gliding exercises for relief. Above all, the therapy should help people to help themselves with vertebral gliding. Continuing exercises consistently after completion of the guided physiotherapy is crucial for the success of the therapy.

Also one electrotherapy can help with spondylolisthesis. Current flows reduce the pain and activate the muscles.

In some cases, the doctor prescribes aids such as shoe inserts or trunk orthoses, which the orthopedic technician customises.

In children with spondylolisthesis, the focus is initially on good muscle training. Until the completion of bone growth, they are closely monitored for disease progression. Special stress on the spine should be avoided. For more severe cases, surgery to stiffen the affected spine area may be useful.

Operative therapy

Surgical procedures for treating spondylolisthesis are called spinal fusion. An operation stabilizes the vertebrae in their correct position, stiffens them and relieves the nerves. This stabilization is also of particular importance for the biomechanics of the entire spine and the correct load distribution.

An operative procedure is not necessarily necessary. Factors that speak for an operation are:

• The burden of spondylolisthesis is high.
• Conservative therapy does not help enough.
• The vortex gliding progresses or is very pronounced.
• There are neurological symptoms such as B. Reflex failure, sensory or motor disorders.
• The patients are not old yet.

Against surgery speak of a high age and a strong osteoporosis. These two factors increase the risk of surgery and significantly reduce the probability of success. Nevertheless, an operation may also be useful in these cases. For example, surgical treatment may be useful for persistent, progressive, or recurrent impairments. A generally clear indication for surgery are nerve disorders such as sensory and motor disorders.

Risks of surgery are mainly general complications such as wound healing disorders or vascular and nerve injuries. The mobility of the spine may be reduced following surgery.

After a vertebral gliding operation, a physiotherapeutic follow-up should be provided. In addition, it is sometimes necessary to wear a medical corset for stabilization for some time.

Spondylolisthesis: disease course and prognosis

Not every spondylolisthesis progresses. The eddy gliding can also stabilize. For example, progression can be prevented by consistent therapy. If a spondylolisthesis is aggravated, the symptoms of movement and nerve disorders also increase. When the problems get worse quickly, a determined therapeutic intervention is needed.

The quality of life can be very limited by stronger complaints. Therefore, it is important to identify those affected early remedy options and determined to treat. However, surgical treatment should not be premature. Already by adjusting the physical stress and supporting physiotherapy relieve the symptoms. Through a three-month, intensive conservative therapy of spondylolisthesis In most cases the symptoms improve considerably.