Spondylolisthesis of the spine is a pathology of the vertebral column, which is expressed in different degrees of displacement of the body of the overlying vertebra relative to the underlying directed in the horizontal plane.
This shift disrupts the normal condition of the tissues of the spine, which is manifested by appearance of the characteristic neurological symptoms – changes occur due to narrowing of the spinal canal or injury to spinal nerve roots.
The reasons for the development of the disease
It is proved that the causes of this disease often becomes a complex of causes – pathological changes develop as a result of:
- the presence of congenital anomalies of the structure of the spine – in this case, developing dysplastic spondylolisthesis, which is characterized by the existence of the defect, allowing the overlying vertebrae “move” forward;
- chronic traumatic stress – in this case, developing istericeski spondylolisthesis, which is characterized by the formation of the acquired defect between the body of the vertebra and its arch – it is joint flexibility of the spine. This variant of the disease often develops among the professional athletes, who by occupation have excessively flexing the spine in different directions;
- degenerative processes affecting the intervertebral discs and ligaments surrounding the spine – degenerative spondylolisthesis develops in older patients or patients suffering from inflammatory diseases of the joints of the spine (ankylosing spondylitis, seronegative arthritis)
- direct trauma of the spine leading to fractures of the arches and articular processes of the individual vertebra with traumatic spondylolisthesis the body of the vertebra is pulled away from the shackle;
- malignant tumors or metastatic lesions of vertebral bodies – the pathological spondylolisthesis in the majority of cases develop in the case when the vertebra collapses tumor process.
To the comprehensive survey it is often impossible to tell what type of spondylolisthesis of the spine occurred in a patient. The prognosis of the disease and possible tactics of treatment depends on the type and severity of pathological changes and the patient’s age – early access to a doctor helps to detect emerging changes before a patient displays symptoms indicating the involvement of the membranes and substance of the spinal cord or spinal nerve roots.
The symptoms of the pathological process
In that case, when a patient develops this disease, the symptoms of the pathological process directly depend on the Department in which the vertebral column have any such offset.
In the occurrence of cervical spondylolisthesis, the patient may receive pain in the neck, extending to the entire upper extremities and upper back, headaches, dizzy spells, and the severity of manifestations increase after exercise, sometimes even negligible. Very often the symptoms of the disease resemble symptoms of complicated osteochondrosis of the spine, which is accompanied by the formation of hernias and protrusion of the discs.
Spondylolisthesis of the lumbar develops and is diagnosed most often – depending on the degree of displacement severity of disease manifestations can vary from mild pain in the lower back (lumbar and sacrum), which increases sharply after attempting to perform the exercises accompanied by stretching of the spine, to a sharp limitation of mobility of the spine and symptoms of neuritis. If there is a shift of the lumbar vertebrae relative to each other, the patient may experience symptoms lumbalgia or lumbago (inflammation of lumbar nerve).
In the case where the developing spondylolisthesis l5, the patient is shifted, relative to each other the body of the last lumbar vertebra and the vertebrae forming the sacrum, and therefore develop signs characteristic of inflammation of the sciatic nerve (sciatica). In this case, it most often develops istericeski spondylolisthesis in a patient can receive complaints of severe pain in the lower back that spread along the nerve (in the area of innervation of its branches). Accordingly, this may appear numbness, tingling or weakness in the legs, wasting of the muscles of the pelvic region and lower limbs. In severe course of the disease can manifest pelvic disorders, the patient loses the ability to control emptying of the bladder and intestines.
If istericeski spondylolisthesis begins in early childhood, the active progression of the pathological process most often begins in the period of active growth of the organism and the first attacks of back pain occur in adolescents. After growth of the skeleton in this case the progression of change is slowing, but the associated trauma may cause the acute deterioration of the spine and surrounding tissues.
Depending on the severity of the changes there are the following degrees of severity of the disease:
- the first – the offset does not exceed 25% of the body of the overlying vertebra;
- second – degree skid according to x-ray remains at 25-50%;
- the third offset is limited to the limit 50-75% of the surface of the vertebra;
- fourth – degree offset exceeds 75% of the surface of the body overlying vertebra;
- fifth – spondylitis, in which the overlying vertebra slips forwards and down.
It depends on the severity of pathological changes and their rate of progression is chosen tactic, according to which will be the treatment of spondylolisthesis.
How to choose the best treatment?
For the diagnosis of disease and selection of the optimal treatment strategy is most often used x-rays, CT or magnetic resonance imaging. To clarify the nature of neurological symptoms necessarily comprehensive neurological examination help to clarify the exact localization of the lesion and the degree of involvement of tissues of the nervous system.
In the initial stages of the disease (first and second) spondylolisthesis of the spine treated by conservative methods. In the treatment program include:
- nonsteroidal anti-inflammatory drugs prescribed a short course – they help to quickly arrest the pain and unpleasant symptoms, but have no impact on the cause of the disease;
- muscle relaxants – used only in the presence of wymaganego pain syndrome under medical supervision;
- epidural injections of steroid hormones or novocaine blockade.
2. Physiotherapy treatment helps eliminate signs of inflammation of the nerves and stimulate the muscles of the back and abdominals.
3. Exercises spondylolisthesis at in the complex of medical procedures actively use gymnastic exercises. The aim of destination therapy is to create a developed muscular corset back, which can support the modified vertebrae. Exercises are chosen for each patient individually. From a complex no exercises are capable to provoke any hyperextension of the tissues of the spine.
4. Orthopedic correction is definitely wearing a corset, which is adjusted individually. This device prevents hyperextension, which can occur when performing even the usual loads, and fixes the vertebrae relative to each other.
In identifying a significant degree of severity of spondylolisthesis of the spine or its rapid progression, the podiatrist may recommend the patient surgical treatment. The operation in this case may involve the formation of fusion – fusion of two adjacent vertebrae or the installation of locking plates.
Early detection of the disease at an early stage of his active and persistent treatment is the key eliminate the unpleasant symptoms and successful recovery.