Vertebral Slippage (Spondylolisthesis)

Vertebral Slippage (Spondylolisthesis)

Spondylolisthesis is a spinal disease in which one or more vertebral bodies shift against each other ( sliding vertebrae ) and thus lead to a loss of stability in the spine. Depending on the extent and progression of the disease (involvement of the nerves, spinal canal stenosis), spondylolisthesis can usually be treated well with conservative measures.

What is whirling?

Vertebral slippage or spondylolisthesis is the sliding of a corpus vertebrae (vertebral body) over the underlying vertebral body, which can be differentiated according to acquired (wear, trauma, overload) and genetically determined forms (spondylolysis). For definitions of hlhs, please visit topbbacolleges.com.

The vertebrae can be displaced either forwards (ventrolisthesis or anterolisthesis) or backwards (retrolisthesis). In most cases, the lumbar vertebrae, especially the 5th lumbar vertebra, are affected by spondylolisthesis, which is often asymptomatic and causes no symptoms.

Spondylolisthesis can manifest itself in the form of stress-related back and lower back pain and a feeling of instability in the affected area. Rarely, root compression syndrome (irritation of the root of a spinal nerve in the affected area of ​​the spine) can occur as a result of narrowing of the spinal canal, leading to neurological symptoms.

Causes

Spondylolisthesis can be either genetic or acquired. Age-related changes in the spine, especially in the intervertebral discs, which lose height with age, cause the ligaments that stabilize the spine to lose their elasticity.

As a result, the vertebral bodies lose stability so that they can shift against each other (degenerative vertebral slippage). This wear and tear process is favored by insufficient movement and a weak trunk musculature. In addition, fatigue lesions or fractures in the pars interarticularis of the vertebral arch as a result of excessive strain on the spine (usually in competitive sports such as javelin throwing, pole vaulting, weightlifting) can lead to vertebral slippage (isthmic spondylolisthesis).

In addition, a severe trauma with injuries to the spine or an operation on the spine can cause slipped vertebrae (post-traumatic spondylolisthesis). If the structure of the spine is disturbed as a result of a congenital defect in the vertebral arches (spondylolysis), this is referred to as congenital or dysplastic vertebral slippage. In rare cases, the vertebral slippage can be attributed to a tumor or inflammation (pathological spondylolisthesis).

Symptoms, Ailments & Signs

Various symptoms and complaints can occur when a vertebra slips. However, it is possible that non-specific low back pain occurs only occasionally. These are mostly load-dependent. It even happens that a spondylolisthesis is completely symptom-free. In this case, it is often diagnosed incidentally. Whether the freedom from symptoms is maintained over the years is another question.

The resulting symptoms of spondylolisthesis are caused by the slipping of the vertebrae. There is a feeling of pressure and pain in the area of ​​the lumbar spine. These can also radiate into the thighs. In other cases, sciatic pain arises. These are often attributed to other events and not necessarily to the spondylolisthesis.

Occasionally there is a feeling of tension or muscle cramps in the legs during the course of the spondylolisthesis. There, the gliding vertebrae can also make themselves felt through muscle weakness. Again, this symptom does not necessarily indicate slipped vertebrae. Because there are four degrees of severity of sliding vertebrae, symptoms can be mild, moderate, or severe. The instability symptoms can suddenly become worse under stress.

Some symptoms suggest that nerves are involved in the pain. Much more often, however, the slipped vertebrae is the cause of other symptoms, for example after a herniated disc or arthrosis of the facet joint. Both are characterized by severe pain that is deep in the small of the back.

Diagnosis & History

Spondylolisthesis is usually diagnosed using an X-ray. Vertebral slippage can be seen in the lateral view in the form of a movement-independent fixed displacement of the affected vertebral body.

At the same time, statements on the severity of spondylolisthesis (grading according to Meyerding) and changes in the spine (curvatures, joint arthrosis, intervertebral disk changes, osteoporosis ) are possible. Computer and magnetic resonance imaging are also used to determine whether soft tissue or nerves are involved.

In some cases, congenital slipped vertebrae in an advanced stage can be diagnosed based on the gait (tightrope walk). Depending on the presence of other impairments (nerve involvement, spinal canal stenosis), spondylolisthesis has a good prognosis and can be treated well with conservative measures in the case of minor symptoms.

Complications

Those who have sliding vertebrae also know them under terms such as vertebral sliding or spondylolisthesis. Acquired spinal disease most commonly affects the fourth or fifth lumbar vertebrae. Since slipped vertebrae is divided into four degrees of severity – from Meyerding I to IV – complications are not uncommon with higher degrees of severity.

One of the most common complications of slipped vertebrae is severe low back pain, which defies any physiotherapeutic treatment. In case of such complications, surgical interventions are a solution. In the case of severe spondylolisthesis or spondyloptosis with pain conditions lasting more than six months, an operation may have to be performed.

Surgical stiffening of the sliding vertebrae is an option. The direct screwing of the spondylolysis in the vertebral arch can already be carried out in severely affected children. Scarring and nerve injuries can occur as a result of this operation. Screws often break as a result of renewed stress on the stiffened vertebral joints. These require another operation.

Acquired spinal instability can pinch nerves in the spinal canal. In addition, surrounding nerves can be overstretched. Nerve damage or functional failures in the area of ​​the surrounding nerves can occur. Paralysis is possible as a result of the pressure on nerve cords. These can affect the legs, but also the bladder and other digestive organs. Due to the sliding vertebrae, there is also increasing wear and tear on the affected intervertebral discs and vertebral joints.

When should you go to the doctor?

If the person concerned complains of pain or irregularities in the back area, this should be monitored further. If it is a one-off situation of overloading or incorrect loading of the skeletal system, improvements can be seen within a short time after sufficient rest and rest. If freedom from symptoms is determined after a night’s sleep, in most cases the person concerned does not need a doctor’s consultation.

However, if the discrepancies in the back area show a steady increase or persist unabated over a longer period of time, a doctor should be consulted. Restrictions in mobility and disturbances in the general movement sequences indicate a health problem. Muscular disorders, feelings of tension and a continuous decrease in physical performance must be examined and treated. Although there are phases in which some of those affected are symptom-free, there is a need for action as soon as the impairments develop sporadically.

If you feel tight or feel uncomfortable when you exert slight pressure on your back, you should consult a doctor. These are warning signals from the organism that call for medical care. If the person concerned has the overall feeling of instability in the area of ​​the spine, it is advisable to see a doctor for a check-up. The perceptions should be discussed so that medical testing can be initiated.

Treatment & Therapy

In most cases, spondylolisthesis is initially treated conservatively. Conservative therapy aims to reduce the existing pain with pain-relieving medication and strengthen the trunk muscles with physiotherapeutic, physical and physiotherapeutic measures.

To relieve and stabilize the spine, the torso and abdominal muscles are individually trained as part of physiotherapy. For regular exercise, which is a basic building block of therapy, back-friendly sports such as cycling, back swimming and Nordic walking are also recommended. In some cases, a corset (Lindemann bodice) is also used to stabilize the spine and immediately reduce pain, although this should only be worn for a short time to avoid weakening the core muscles.

Physical measures such as massages also support pain reduction, while back training can contribute to a spinal and intervertebral disc-friendly gait and everyday behavior. If, despite conservative therapy, there is no improvement in symptoms after 6 months, or if the nerves are involved or spinal canal stenosis is present, surgical intervention may be indicated.

In the case of spinal canal stenosis, for example, the spinal canal can be widened as part of a laminectomy or surgical decompression and the unstable vertebral bodies can be stiffened (spondylodesis). In adolescents with pronounced congenital slipped vertebrae, the affected vertebra is returned to its original position (reposition) prior to the spondylodesis.

Prevention

Spondylolisthesis can only be prevented to a limited extent. However, a strengthened and trained trunk musculature, everyday behavior that is gentle on the spine and intervertebral discs, and regular exercise contribute to minimizing the risk of slipped vertebrae and slowing down the progression of spondylolisthesis.

Aftercare

Follow-up care plays an important role in both conservative and surgical treatment of slipped vertebrae. A conservative therapy is followed by orthopedic rehabilitation measures, which are accompanied either by the family doctor or an orthopedist. Conservative measures are usually considered more promising than surgical interventions.

For the follow-up treatment of spondylolisthesis, physiotherapy exercises have proven to be effective as rehabilitation measures, which can be combined with sporting activities, relaxation exercises and psychotherapy. Rehab involves an intensive program that takes several weeks to complete. However, the patient must no longer suffer from acute pain.

For this purpose, he receives pain medication and muscle-relaxing preparations. The freedom from pain means that the patient can move regularly again and train his muscles. The focus is on building up the back and abdominal muscles. The cooperation of the patient is also extremely important for the success of the treatment. If the vertebral slippage has to be treated surgically, follow-up treatment is also required. Depending on the scope of the operation, the patient stays in the clinic for about a week.

It usually takes twelve weeks before rehabilitation can begin, so that the body has enough time to recover. After gradually removing the stabilizing corset, physiotherapeutic exercises that strengthen the back muscles begin. There is also a check-up three months after the operation to check the stability of the spine.

You can do that yourself

People with slipped vertebrae (spondylolisthesis) have the opportunity in everyday life to reduce their symptoms through various measures and to prevent a worsening of the disease. In many cases, certain types of sport are the trigger for the slipping of the vertebrae, so that those affected initially start at this point.

It is advisable to reduce the intensity of exercise and contact a physiotherapist. Even certain exercises before the actual sport can help to reduce the risk of deterioration. In general, it is helpful to seek physiotherapeutic treatment and to strengthen the muscles near the affected section of the spine in a targeted manner and with professional support. This also reduces symptoms and improves the prognosis. The patient, his trainer and the physiotherapist must decide together whether a change of sport is necessary in the individual case.

Exercising less back-stressing sporting activities makes sense in any case and usually has a beneficial effect on the state of health. Sometimes patients are asked to wear a corset for a period of time to support the spine. Those affected should comply with this recommendation in their own interest, even if this involves temporary restrictions in everyday life and when exercising.

Vertebral Slippage (Spondylolisthesis)