Displacement of vertebrae( spondylolisthesis) - Causes, symptoms and treatment. MF.

Spondylolisthesis - is the displacement of the vertebrae anteriorly as a result of spondylolysis( congenital non-growth of the vertebra of the vertebra with its body) or degenerative changes in the intervertebral disc. It is often observed when the 5th lumbar vertebra is displaced with respect to the sacrum.

Spondylolysis is a defect in one of the vertebrae of the lumbar spine. Most often, spondylolysis develops in the fifth lumbar vertebra. With this disease, the vertebra pedicle is fractured( fractured).The vertebra foot is an anatomical formation that connects the vertebral body to the facet joints. The legs of the vertebra are involved in the formation of the vertebral and foraminal openings, in which the nerve structures( spinal cord and nerve roots) are located. In spondylolysis, the posterior part of the vertebra( leg, facet joint and vertebra) is connected to the vertebral body with scar tissue only. In most cases, the cause of this condition is the fracture of the vertebral foot that has not fractured. In most cases, spondylolysis is not a congenital pathology, but an acquired disease. In this case, the fracture of the vertebral pedicle occurs in childhood, often during gymnastics, football, wrestling and other sports. Thus, spondylolysis is a stress fracture of the vertebral pedicle, which never fully fuses.

The term spondylolisthesis means slipping of the vertebra, relatively inferior to the front or back. When slipping forward, anterior spondylolisthesis develops, and when slipping backwards, posterior spondylolisthesis occurs. In most cases, the spondylolysis described above leads to the development of spondylolisthesis. The most important structures ensuring the stability of the vertebral-motor segment are the disc and facet joints. In spondylolysis, the facet joints can not keep the vertebra from slipping. The intervertebral disc under the influence of loads slowly stretches, which facilitates the slipping of the overlying vertebra. In many cases, for several years, slipping is extremely limited and does not represent a clinical problem. However, with age, the degree of spondylolisthesis may increase, which leads to pain in the lower back. As a rule, back pain caused by spondylolisthesis is noted in patients older than 35 years.

Symptoms of spondylolisthesis

The main symptom of spondylolysis and spondylolisthesis is chronic pain in the lumbar region. However, it is not absolutely necessary that all patients with spondylolisthesis have back pain. Spondylolisthesis simply increases the risk of developing a chronic pain syndrome in the back compared to other people in the population. Spondylolysis / spondylolisthesis can lead to the development of mechanical pain and radicular pain( radiculopathy).Pain of a mechanical type is caused by instability of the vertebral-motor segment as a result of slipping of the vertebra. Radicular pain occurs when the nerve root is compressed( compressed) by dense structures( bones and ligaments).In the fracture site, often scar tissue is formed in excess, which can lead to compression of the nerve root in the foraminar orifice. In addition, the displacement of the overlying vertebra forward can contribute to the development of spinal stenosis.

Usually, pain in spondylolysis / spondylolisthesis is localized in the lower back, often radiating to the gluteal region. In many patients, back pain is aggravated by loosening of the lower back. When squeezing the nerve roots, patients notice pain in the legs, which is accompanied by weakness and numbness of a part of the limb.

Diagnosis of spondylolisthesis

Diagnosis of spondylolysis and spondylolisthesis is established by radiography, computed tomography or magnetic resonance imaging. In most cases, this disease can easily be diagnosed with conventional radiography of the lumbar spine.

However, the diagnosis of "spondylolisthesis" does not mean that this disease is the cause of back pain that bothers you. Back pain can be caused by a disc herniation and many other diseases. The doctor, before establishing the connection of pain with spondylolysis / spondylolisthesis should rule out all other possible causes of back pain.

To make a diagnosis, the doctor first examines in detail the complaints and the history of the disease. During the questioning you may be asked the following questions:

when there was pain in the back?
character of pain: intensity, location, association with movement of
, are there oneplay and / or weakness of part of the limb?
are there any disorders in the function of the pelvic organs( bowel movements and urination)?

After questioning by the doctor, the patient is physically examined. It consists of examination, palpation of painful areas, testing of tendon reflexes, skin sensitivity, muscle strength, nerve root tension symptoms.

Additional diagnostic methods are required to confirm the diagnosis. The most informative research methods for spondylolisthesis are radiography of the spine and magnetic resonance imaging( MRI).Radiography can reveal the degree of spondylolisthesis, and the MRI allows you to assess the state of the spinal cord and nerve roots, which can be involved in the pathological process.

Treatment of spondylolisthesis

Conservative treatment of spondylolisthesis

Treatment of spondylolysis / spondylolisthesis is carried out according to the algorithm for the treatment of pain associated with instability of the spine or compression of the nerve roots. In many cases, conservative therapy is effective enough. The fundamental element of therapy is the strengthening of the muscles of the back and abdominal press( the creation of a muscle corset), which leads to a decrease in the degree of instability of the spine. With a pronounced pain syndrome, medication is prescribed, aimed at arresting pain and reducing muscle spasms in the near-vertebral muscles. In case of acute painful episodes, the doctor may be given a corset for a short time. However, it should be remembered that prolonged use of the corset belt contributes to weakening of the back muscles, which leads to an increase in spinal instability and an aggravation of the process.

Surgical treatment of spondylolisthesis

The indication for surgery is the inefficiency of conservative therapy in the treatment of pain syndrome. The operation consists in stabilizing the spine and decompressing( reducing compression) of the nervous structures. In most cases, laminectomy( removal of the vertebra of the vertebra) is performed for revision and decompression of the nerve roots and spinal cord. The surgeon removes excess scar tissue in the area of ​​spondylolysis, which can squeeze the nerve roots. Next, stabilization of the spine is performed to eliminate the instability of the vertebral-motor segment.