what is the spondylolisthesis and its symptoms treatment

spondylolisthesis curses both males and females with an affected erect posture.

The medical community generally accepts spondylolisthesis as the slow anterior displacement of a vertebra at the lower lumbar spine, specifically as the lowermost vertebra L5 slipping forward on the first sacral segment S1.

in this condition there is a interruption in the concavity of the par interarticularis

And on the other hand spondylolysis is the defect in the pars exists but without the forward slipping. this could be due to a fracture, stress fracture or nonunion.

Types of spondylolisthesis

Dysplastic

Congenital defects in the superior sacral facets result in a slow yet relentless forward slip, ultimately causing severe displacement.

Cases of spondylolisthesis commonly have associated anomalies, typically spina bifida occulta.

Lytic or isthmic

Defects in the pars interarticularis (spondylolysis), or repeated breaking and healing, can lead to elongation of the pars, making it the most common variety.

The defect (which occurs in about 5 per cent of people) is usually present by the age of 7, but the slip may appear only some years later (Eisenstein, 1978; Fredrickson et al., 1984).

While it is challenging to rule out a genetic factor due to the tendency for spondylolisthesis to run in families and its higher occurrence in specific races, such as Eskimos, the incidence rises with age up to the late teenage years. However, clinical symptoms, including pain, can persist into late middle age.

An acquired factor probably supervenes to produce what is essentially an ununited stress fracture.

The condition is often more prevalent among competitive gymnasts and weightlifters, whose spines are exposed to exceptional stresses.

Degenerative

Degenerative changes in the facet joints and the discs permit forward slip (nearly always at L4/5 and mainly in women of middle age) despite intact laminae.

Many of these patients have generalized osteoarthritis and pyrophosphate crystal arthropathy.

Post-traumatic

Uncommon fractures can lead to lumbar spine destabilization.

Pathological

Generalized or localized bone disease (e.g. due to tuberculosis or neoplasm) may cause vertebral slipping.

Postoperative (iatropathic)

Occasionally, excessive operative removal of bone in decompression operations results in progressive spondylolisthesis

Signs and Symptoms

  1. Increased lumbar lordosis occurs.
  2. the transverse furrow over the lower back are unmistakable features of spondylolisthesis
  3. A step is palpable at the site of lesion( step sign )
  4. It can be asymptomatic or with low back pain
  5. The abdomen protruded forward.
  6. Sacrum is vertical
  7. buttocks can be flat and hamstring tightness
  8. You can prominently feel the L5 spinous process.
  9. The condition may involve the L5 nerve root.
  10. one cannot bent beyond the lower thigh

Diagnosis and Evaluation

For diagnosis, the most important investigation performed is radiology of the spine.

anteriorposterior and lateral films are helpful

And oblique view of lumbar spine demonstrates the defect in the pars very accurately as a “scottie dog ” sign

The Scottie dog’s neck, which represents the pars defect, is broken in the isthmic variety.

The edges of the defect may appear smooth and rounded, suggesting a pseudoarthrosis rather than an acute fracture.

CT scan and MRI are also an essential investigations

Conservative Treatment

one can divide spondylolisthesis into three groups based on the severity of symptoms.
  1. asymptomatic
  2. mild-to-moderate
  3. severe

In Asymptomatic Conditions

an individual is asked to correct the poor posture

elimination of any stressfull activity or occupation which can become an risk

certain types of sports activities are asked to be avoided

In Mild-to-Moderate

alleviation of anxiety is the first step

analgesics and muscle relaxants are used

deep heat or hot packs can be used

mild exercises are asked to be done

In Severe Condition

rest is the primary component

NSAIDs

Gradual exercises to strengthen the trunk and hamstrings muscles

Surgical Management

Indication for surgery

  1. failure of conservative therapy.
  2. signs of root compression.
  3. progressive slipping.
  4. slip of more than 30% even when painless.
  5. persistent pain in back, thigh or persistence sciatica.

Common Methods Used for Surgery

Posterolateral fusion : this is the best method of fusing the slipped vertebra because it perseveres the supporting soft tissues and has a high rate of fusion

posterior fusion : in this method, postoperative and addition slip is frequent until the fusion is solid. this also has a high rate of pseudoarthrosis and has to be done with intertransverse fusion

laminectomy : This procedure primarily aids in alleviating neurological deficits and must be followed by posterolateral fusion for optimal results.

anterior interbody fusion: Surgeons indicate this procedure for subtotal spondylolisthesis, and it is a risky and difficult procedure with doubtful efficacy.

methods of fusion and stabilization : In spondylolisthesis, surgeons achieve fusion by placing autologous cancellous bone graft, and they use Harts Shill rectangle frame or Steffee plate and screws to obtain stabilization.

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