Diseases

Spondylolisthesis - symptoms, causes and treatment

Spondylolisthesis - symptoms, causes and treatment / Diseases

Spondylolisthesis - spondylolisthesis

Slippage of a vertebra is referred to in the medical terminology as spondylolisthesis. Various causes can cause this deformation of the spine and cause mild to very severe lower back complaints. It is also possible that those affected have no symptoms. If the findings of a spondylolisthesis are present, first conservative treatment forms are used. In rare and severe cases, stiffening surgery on the spine may be advisable.


contents

  • Spondylolisthesis - spondylolisthesis
  • A short overview
  • definition
  • symptoms
  • causes
  • diagnosis
  • treatment
  • Naturopathic treatment
  • What else can you do?

A short overview

Back pain or low back pain can have a variety of causes. In rare cases, a vortex gliding is present. The following summary will briefly explain what is meant by this condition, while the other article provides detailed information for those affected and interested.

  • definition: Spondylolisthesis is the sliding of a vertebra, usually in the lower lumbar region, where the entire overlying spine also shifts in position. There are different forms and degrees of severity of this disease, where the true vertebral gliding is characterized by a gap formation between the articular processes of a vertebral arch (spondylolysis).
  • symptoms: The mild forms are often asymptomatic. If complaints occur, these are usually back pain and low back pain together with a break through feeling, which leads to difficulties in erecting the trunk.
  • causes: The causes are varied and range from occurring bone damage in the vertebral joint, to acquired fractures or wear processes (pseudo-Spondylolisthesis), to congenital malformations.
  • diagnosis: Thorough orthopedic examination of the spine and special X-ray images make it possible in most cases to detect a sliding vertebra.
  • treatmentAlmost every treatment is based primarily on conservative therapies that include back exercises, various physical therapies, and, if necessary, analgesics. Surgery is only considered in rare, serious cases.
  • Naturopathic treatment and other alternativesIn symptomatic treatment, heat therapy and other home remedies for back pain can help. Other alternative methods for supporting the healing process include homeopathic treatments and Schuessler salts.
Spondylolisthesis is a rare lower back deformity, also known as vertebral gliding. (Image: stockdevil / fotolia.com)

definition

The medical term spondylolisthesis (also known as spondylolisthesis) derives from the Greek and means spondylosis ("spondylos" and "olisthesis"). It is a deformity or instability of the spine and the back, in which a so-called sliding vertebra slips over an underlying vertebral body. Most often, there is a shift forward (on the belly) and it is called a Ventro- or Anterolisthesis. If, on the other hand, the vertebra slips backwards, this is called a retrolisthesis.

During the movement of the gliding vertebra, its arch roots, transverse processes and the upper articular processes are also moved so that the entire overlying spinal column section also moves with it.

The vertebral body gliding usually occurs in the area of ​​the lumbar spine and is subdivided into different forms and manifestations depending on the origin (for example innate or acquired) and severity. The true spondylolisthesis (spondylolisthesis vera) is distinguished by a gap formation in the bony vertebral arch (spondylolysis) from the purely degenerative form without a cleft, the so-called pseudo-spondylolisthesis, as a differential diagnosis. A similar clinical picture without sliding vortex represents the spondylosis.

In most cases, spondylolisthesis occurs on the fifth lumbar vertebra, which slides forward in the most common cases. (Image: Henrie / fotolia.com)

symptoms

About half of those with (accidentally) diagnosed spondylolysis or spondylolisthesis have no symptoms. If symptoms occur, they are rather unspecific and initially difficult to distinguish from the symptoms of other spinal disorders, such as a herniated disc.

Most of the time it is reported back pain or low back pain. This is due to the fact that the lower spine is primarily affected by the fifth (80 percent) or fourth (15 percent) lumbar vertebrae (L5 / S1 or L4 / L5). The pain in the lumbar spine (lumbar spine) is usually associated with stress and movement. By exerting pressure on the spinous process of the affected lumbar vertebra, it is then usually possible to cause pain even when at rest. It can also lead to a feeling of instability at the spine (Durchbrechgefühl) and to increased hollow cross formation (hyperlordosis).

If the pain radiates, for example, into the buttocks and legs, it is often equated with sciatica. Reason for this are nerves, which are trapped by the slipping of the vertebra. In very severe cases, neurological deficits may also arise, which may lead, for example, to disorders of bladder function and bowel function or abnormal sensations in the legs.

In the pronounced forms, a kind of step on the sliding vortex can be visible and palpable from the outside (ski jumping phenomenon), whereby in most cases the sacrum also protrudes conspicuously to the rear. Other consequences may include restricted mobility, poor posture and skeletal deformities, such as scoliosis. Sufferers sometimes have to bend their knees to be able to stand upright or are no longer able to bend their hips. This can also cause hip pain.

Not all sufferers have complaints. However, pain often occurs in the lower back, which is sometimes difficult to classify. (Image: BigBlueStudio / fotolia.com)

causes

The most common cause of vertebral gliding is the occurrence of spondylolysis (also spondylolysis). This is the interruption of the interarticular portion (also called pars interarticularis), which forms the portion of the bone between the upper and lower articular processes of a vertebral arch. This creates a gap that damages or loosens the joints and thus allows slipping. The causes of this can in turn be acquired in the course of life due to various circumstances or in some cases also innate.

Classification by cause and consideration of additional factors (including Wiltse, Newman, Macnab, and Rothmann) have led to the description of various forms and (sub-) types. The most common classification distinguishes the following types:

  • Type I - dysplastic,
  • Type II - isthmic,
  • Type III - degenerative,
  • Type IV - traumatic,
  • Type V - pathological,
  • Type VI - postoperative.

In a dysplastic form, also known as type I, it is congenital malformations (dysplasia) on the vertebral joints, the articular processes or especially at the junction between the lumbar spine and the sacrum, which promote the sliding of a vertebral body. These malformations usually occur together with a spina bifida.

The isthmic form (type II) is mainly caused by fractures (stress or fatigue fractures) of the interarticular portion of a vertebral arch (lysal slit), which can also cause an extension of this bone section. If this area is only cartilaginous and not ossified since birth, it represents a veritable weak spot for a fracture. The innate causes have not yet been sufficiently researched, however, a certain inheritance is suspected.

Another type (type III) can be caused by signs of wear on the vertebral joints and intervertebral discs with degenerative instability but no lysis. This form is therefore also called pseudo-Spondylolisthesis. If trauma occurs elsewhere in the spine, outside the interarticular portion, traumatic type IV is used.

There are many causes for eddy gliding, although certain sports are among the risk factors. (Image: studioessen / fotolia.com)

If the patients have reduced bone, which leads to the dissolution or interruption of the pars interarticularis (for example, osteogenesis imperfecta), this is called pathological spondylolisthesis (type V). Another distinction (type VI) comes into play when the disease develops as a result of spinal surgery (postoperatively).

The risk factors include, above all, competitive sports that have harmful effects on the spine due to frequent and intensive overlapping and overexpansion as well as other extreme stresses (including gymnastics, javelin throwing, dolphin swimming, weightlifting, wrestling).

diagnosis

If there are back problems that require a more detailed examination, an orthopedic examination is used in most cases. If there is a suspicion of a spondylolisthesis, not only the physical examination is an important part. In order to clarify possible risk factors and causes, a detailed patient survey with a sports and family history is very important.

If, in the external view, malpositions or misalignments of the spinal column in the area of ​​the lumbar spine are visible or palpable (hyperlordosis, ski jump phenomenon), the suspicion of spondylolisthesis is often close. As a rule, in addition to the lower back, the areas of the hip and pelvis are also taken into account during the clinical examination and examined for posture and musculature. In many cases, it is typical that those affected have to lean back to sit up.

Special functional and pain tests are intended to provide further information on mobility and the individual symptoms. Thus, for example, by means of the Schober sign on a simple way to assess the unfolding ability of the lower back and be checked by a slight pressure on the spine of the so-called compression pain. In addition, the reflexes and the sensibility are controlled and possibly supplemented with further neurological examinations (electromyography, measurement of the nerve conduction velocity). In vertebral gliding, neurological deficits are often observed during certain movements.

Orthopedic examinations and X-ray images can provide clarity for those affected. (Image: bixpicture / fotolia.com)

In further diagnostics, an x-ray examination of the lumbar spine is primarily carried out and possibly supplemented by further imaging procedures (magnetic resonance tomography, computed tomography). In rare cases, X-rays using a contrast medium (myelography) or further examinations are necessary, such as bone scintigraphy.

With regard to possible treatment options or also to the differentiation of differential diagnoses, a classification into four degrees of severity according to Meyerding (1932) is made by means of the X-ray images. In this case, the vertebral body is divided directly below the sliding vortex in the side view into four sections, each section represents a sliding of the overlying vortex by 25%. Then you distinguish the following stages:

  • Grade I: < 25%,
  • Grade II: 25 to 50%,
  • Grade III: 51 to 75%,
  • Grade IV:> 75%.

There is no contact between the vertebrae is a complete slipping, what is called Spondyloptosis. According to Meyerding, this corresponds to the degree IV, but sometimes this is also referred to as a degree V-vortex glide. With a low degree (grade I-II) and without complaints, it is not uncommon for random findings.

treatment

The treatment goals include combatting the symptoms, such as alleviating or eliminating pain and possible neurological deficits, as well as improving or at least maintaining the severity of the condition being diagnosed. Corresponding treatment options are basically differentiated into two forms, which are based on the current stage. In mild cases, conservative treatment is usually sufficient; in severe cases, surgical treatment may be required.

The first therapeutic measures include consistent physiotherapy with back exercises. (Image: Racle Fotodesign / fotolia.com)

Conservative therapy

As a rule, those affected will first be informed about various ways of relieving the affected spine. These include counseling sessions with regard to a healthy diet and exercise, for example for weight loss and avoidance of harmful physical stress in everyday life (workplace, sports activities).

Often, a drug treatment is called in for acute pain relief. It uses analgesic and anti-inflammatory drugs (analgesics, anti-inflammatory drugs), sometimes with local injections. In addition, muscle relaxants are also used to relax the skeletal muscles.

Furthermore, the physical therapies are considered very effective. This includes first and foremost a consistent and regular physiotherapy especially for stabilization and relief of the spine. In this context, a back school provides important assistance in dealing with the illness through consultations and exercises with regard to a correct posture in everyday life and a special muscle training.

Also, an extension treatment in which muscles and joints are stretched and stretched with force or electrotherapy may be consulted. Sometimes a temporary layer storage makes sense and relieves. Custom shoe insoles or core orthoses can also relieve pressure and relieve symptoms.

In any case, follow-up checks make sense. If it comes to a worsening or is present from the beginning of a severe form of spondylolisthesis, a surgical procedure may be necessary.

Surgery is just the last treatment option and should always be weighed up. (Image: Syda Productions / fotolia.com)

Operative therapy

If the sufferer suffers from severe and painful spondylolisthesis, possibly also with functional impairments of the nervous system, and previous treatment approaches have failed, surgery may be an option. In the balance for or against an operative method, however, age and other illnesses also play a role. Patients who have reached a high age or have osteoporosis may lead to a contraindication despite the existence of the other factors.

The surgical procedure used for this disease to stiffen the affected spine area is called spinal fusion (vertebral body block). The goal here is to restore the full capacity of the spine and, if necessary, to remedy neurological impairments. This leads to interventions with or without reduction of the slipped vertebral body.

Like any other surgery, this procedure involves general risks and may also result in specific complications and consequences, including but not limited to, restriction of movement or neurological disorders.

Physiotherapy is a key part of rehabilitation in postoperative follow-up and may require the occasional wearing of a corset.

Naturopathic treatment

In addition to conservative therapy, there are also some natural healing methods that can relax muscles and relieve pain. These include, for example, the heat therapy and especially with only a slight back pain, some home remedies, such as a warm bath, help. The progressive muscle relaxation can relieve some sufferers.

What else can you do?

If there are no serious health conditions that require conventional medical treatment, those affected may also consider other alternative measures to relieve persistent symptoms. These include, above all, homeopathy, aromatherapy or the intake of certain Schuessler salts. In any case, however, a medical advice should be consulted beforehand and the respective treatments should be supervised professionally. (tf, cs; updated 06/02/2019)