Types and degrees of spondylolisthesis
The vertebrae are connected to each other by a disc, ligaments, and a pair of facet joints that prevent them from slipping. If one of the links in this system weakens, the vertebra gradually shifts under the influence of load. Doctors differentiate spondylolisthesis by the cause of its occurrence and by the degree of displacement, which is measured on a lateral X-ray as a fraction of the width of the underlying vertebra. The choice of treatment depends on the type and degree. Displacements of degrees I and II are more common. Backward displacement is called retrolisthesis and is usually associated with disc degeneration.
- Isthmic - due to a defect in the interarticular part of the arch
- Degenerative - due to arthrosis of the joints and disc wear
- Dysplastic - with congenital anomalies of vertebral development
- Traumatic and pathological - after fractures, with tumors
- I degree - displacement up to 25%, II - 25–50%
- III - 50–75%, IV - more than 75%, V - complete slippage (spondyloptosis)
Causes and risk factors
Isthmic spondylolisthesis often begins in childhood and adolescence: with repeated hyperextension of the back, a stress fracture occurs in the interarticular part of the arch. Therefore, gymnasts, wrestlers, weightlifters, football players, and dancers are at risk. In some people, the arch defect exists for years and does not manifest itself in any way. The degenerative form develops in older people: joints and discs wear out, ligaments lose strength, and the vertebra, usually L4, slowly moves forward. Heredity, congenital structural features of the vertebrae, excess weight and weakness of the core muscles are of great importance.
- Gymnastics, wrestling, weightlifting, diving
- Age over 50 years, female
- Hereditary predisposition
- Congenital vertebral anomalies
- Excess weight and core weakness
- Spinal injuries
Symptoms
Small displacements are often discovered by chance on imaging studies. When symptoms appear, the main complaint is low back pain, which gets worse with standing, bending back, or physical activity and gets better with lying down or sitting. When the roots are irritated, the pain radiates to the buttock and leg, numbness and tingling occur. A narrowing of the spinal canal is characterized by neurogenic lameness: when walking, the legs become weak and numb, and you have to stop and sit down. Teenagers often experience tension in the muscles of the back of their thighs, which makes it difficult to bend over. With a significant displacement, posture changes.
- Lower back pain with exertion and standing
- Pain radiating to the buttock and leg
- Numbness, tingling in the legs
- Hamstring muscle tension
- Weakness in legs when walking
- Strengthening the lumbar deflection
Diagnostics
The main method is radiography of the lumbar region in a lateral projection, which determines the degree of displacement. Films with functional tests in the position of maximum flexion and extension show whether the displacement increases with movement, that is, whether there is instability. CT scans well reveal the defect of the arch, and MRI – the condition of the discs, the degree of narrowing of the spinal canal and compression of the nerve roots. For numbness and weakness, a neurologist may order an electroneuromyography to evaluate nerve function. Repeated images over time allow you to understand whether the displacement is progressing.
- Neurological and orthopedic examination
- X-ray of the lumbar region in 2 projections
- Functional X-rays
- MSCT of the lumbosacral region
- MRI of the lumbosacral region
- Electroneuromyography
Treatment
Most patients with degrees I–II displacement benefit from conservative treatment. During periods of pain, the doctor may prescribe nonsteroidal anti-inflammatory drugs, muscle relaxants, and physical therapy; Bed rest is not needed. Physical therapy plays a key role by strengthening the deep abdominal and back muscles that stabilize the spine. The corset is used in short courses. For radicular pain, epidural blocks are possible. Weight control reduces stress on the displaced segment. Surgery - decompression and fixation of the vertebrae - is indicated for a high degree of displacement, its progression, persistent pain and neurological deficit.
- Exercise therapy with core stabilization exercises
- Refusal to hyperextend the back and jump for the period of treatment
- Losing weight if you are overweight
- Physiotherapy as prescribed by a doctor
- Epidural and facet blocks
- Decompression and spinal fusion - when indicated