Spondylolisthesis: History, Classification, Symptoms, Causes, Risk Factors, Diagnosis and Treatment

It is the sliding or displacement of one vertebra in comparison with another.

The word spondylolisthesis derives from two parts, spondylos which means backbone and listesis which means slip.

Spondylolisthesis usually occurs towards the base of the spine in the lumbar area. It is a condition of the spine by which one of the vertebrae slides forward or backward relative to the next vertebra.

The forward gliding of an upper vertebra in a lower vertebra is known as anterolisthesis, while the backward recoil is known as retrolisthesis.

Spondylolisthesis can cause a deformity of the spine, as well as a narrowing of the spinal canal (central spinal stenosis) or compression of the leaving nerve roots (foraminal stenosis).

Spondylolisthesis is more common in the lower back (lumbar spine), but it can also occur in the upper-middle part of the back (thoracic spine) and in the neck (cervical spine).

It becomes more apparent in people who are involved in very physical activities such as lifting weights, gymnastics or soccer.

Men are more likely than women to develop symptoms from the disorder, mainly because they participate in more physical activities.

Although some children under the age of five may be predisposed to having a spondylolisthesis, or may already have an undetected spondylolisthesis, it is rare for these young children to be diagnosed with spondylolisthesis.

Spondylolisthesis becomes more common among children aged 7-10 years. The increase in physical activities of adolescence and adulthood, together with the erosion of daily life, result in spondylolisthesis being more common among adolescents and adults.

History

Spondylolisthesis was first described in 1782 by the Belgian obstetrician Herbinaux.

It is often defined in the literature as displacement in any direction.

However, medical dictionaries generally define spondylolisthesis specifically as the forward or anterior displacement of a vertebra over the inferior vertebra (or sacrum).

Olisthesis is a term that most explicitly denotes displacement in any direction.

The forward or anterior displacement can be specifically called anterolisthesis. Anterolisthesis commonly involves the fifth lumbar vertebra.

The backward movement is called retrolisthesis. Lateral displacement is called lateral listhesis or laterolisthesis.

Retrolistesis

A retrolistesis is a posterior displacement of a vertebral body with respect to the underlying vertebra to a lesser degree than a dislocation.

Retrolistesis is more easily diagnosed in lateral X-ray views of the spine. The views, where care has been taken to expose to obtain a true lateral view without rotation, offer the best diagnostic quality.

The retrolistesis is found mainly in the cervical spine and the lumbar region, but can also be seen in the thoracic area.

Classification of spondylolisthesis

It can be categorized by location and severity.

By location

The location of the sterolistesis includes which vertebrae are involved and can also specify which parts of the vertebrae are affected.

Isthmic anterolisthesis : is where there is a defect in the pars interarticularis. It is the most common form of spondylolisthesis; also called spondylolitic spondylolisthesis, occurs with an informed prevalence of 5-7% in the US population. UU

A slip or fracture of the intravertebral joint is usually acquired between the ages of 6 and 16, but remains unnoticed until adulthood.

Approximately 90% of these isthmic slips are low grade (less than 50%) and 10% are high grade (slip greater than 50%). It is divided into three subtypes:

  • A : fatigue fracture by pairs.
  • B : elongation of pairs due to multiple effects of cured stress.
  • C : acute split of pars.

degree

Slip severity is usually measured after taking a lateral vision radiograph, and then classified on a scale of 1 to 5. Sliding is measured from the amount by which the upper vertebral body slides forward over the body Lower vertebral:

  • Grade I : is a glide of up to 0-25%.
  • Grade II : is between 25-50%.
  • Grade III : is between 50-75%.
  • Grade IV : it is between 75-100%.
  • Grade V : greater than 100% or spondyloptosis, occurs when the vertebra has completely fallen off the next vertebra.

What are the symptoms?

Low back pain is the most common symptom of spondylolisthesis. This often gets worse after exercise, especially with extension of the lumbar spine.

Other symptoms include hamstring stiffness and stiffness and decreased range of motion of the lower back. Pain in the legs, thighs and buttocks can get worse when standing up.

Some patients may develop pain, numbness, tingling or weakness in the legs due to nerve compression.

  • A general stiffness of the back and hardening of the hamstrings, with a resulting change in posture and gait.
  • You can observe a forward inclined or semichototic posture, due to compensatory changes.
  • In more advanced causes, a “slow movement” can be seen due to the compensatory rotation of the pelvis due to the decreased rotation of the lumbar spine.
  • A result of the change in gait is often a noticeable atrophy in the gluteal muscles due to lack of use.
  • Generalized lower back pain can also be seen, with intermittent pain from the buttocks to the back of the thigh and / or the lower part of the leg through the sciatic nerve.

Other symptoms may include tingling and numbness. Coughing and sneezing can intensify the pain.

  • Pain that gets worse when standing, walking, or any type of activity that involves leaning back.
  • Pain that feels better when sitting, especially in a reclined position.

An individual may also notice a “sliding sensation” when moving to a vertical position. Sitting and trying to stand can be painful and difficult.

What causes spondylolisthesis?

A single or repeated force that is applied to the spine can cause spondylolisthesis; for example, the impact of falling off a ladder and falling on its feet, or the regular impact on the spine suffered by offensive linemen playing football.

Type I – dysplastic or congenital spondylolisthesis: dysplastic spondylolisthesis is caused by a defect in the formation of a part of the vertebra called a facet that allows it to slide forward. This is a condition with which a patient is born (congenital).

It is the result of congenital abnormalities, usually occurs in the area where the lumbar spine and the sacrum of the upper sacral facets or lower facets of the fifth lumbar vertebrae, the L5-S1 area, and represents between 14%. and 21% of all anterolisthesis.

Type II – Isthmic spondylolisthesis: in isthmic spondylolisthesis, there is a defect in a portion of the vertebra called pars interarticularis, a particular region of the vertebra. If there is a defect without a slip, the condition is called spondylolysis.

Isthmic spondylolisthesis is further divided:

Type II A : gymnasts, weightlifters and soccer linemen are especially prone to this type of spondylolisthesis. It is caused by multiple microfractures in the pars interarticularis-microfractures that occur due to hyperextension (general) and excessive use. The torque is completely fractured in type II A.

Type II B : this type is also caused by microfractures. The difference, however, is that the pairs do not fracture completely. In contrast, new bones grow as the pair heals and causes it to stretch. A longer pair can cause the vertebra to move forward.

Type II C : like type II A, this type has a complete fracture. However, it is caused by trauma. The impact on a car accident could fracture your peers, for example.

A fracture in pairs can lead to a moving piece of bone; the lower articular process detached can really move.

Problems with the pars interarticularis can also be called spondylolysis. The word looks like spondylolisthesis, and they are somewhat related.

Microfractures in the pars interarticularis, of the type that gymnasts are prone to, football players and weightlifters are a form of spondylolysis.

The fractures are called spondylolysis; If the vertebra slips forward because it is not held in place correctly, it is called spondylolisthesis.

Type III – Degenerative spondylolisthesis: degenerative spondylolisthesis occurs due to arthritic changes in the joints of the vertebrae due to cartilage degeneration and is acquired later in life.

It is a disease of the elderly that develops as a result of facet arthritis and joint remodeling. Joint arthritis and weakness of the yellow ligament can cause a vertebra to slip.

As you grow older, the parts of your spine may degenerate; They can wear out. Usually their intervertebral discs change first.

The older they are, the less water content and proteoglycans have the discs, and the less fluid makes them less able to handle movements and strokes.

Less fluid can also cause the disc to thin out, and a thinner disc brings the facet joints closer together. Degenerative forms are more frequent in women, people over fifty and African-Americans.

Type IV – Traumatic spondylolisthesis : it is rare and is due to direct trauma or injury to the vertebrae. This can be caused by a fracture of the pedicle, lamina or facet joints that allows the frontal portion of the vertebra to slide forward with respect to the posterior part of the vertebra.

Similar to type II C, type IV involves a fracture.

Type V – Pathological spondylolisthesis: Pathological spondylolisthesis is caused by a defect in the bone caused by an abnormal bone, such as a tumor.

Type VI – Surgical spondylolisthesis : also known as iatrogenic spondylolisthesis, and is caused by a weakening of paresis, often as a result of a laminectomy (a typical back surgery, but type VI spondylolisthesis is not a typical result of surgery ).

As a quick summary, spondylolisthesis can be caused by:

  • A birth defect
  • Fractures
  • Degeneration due to age or excessive use.
  • Tumors
  • Surgery.

Which are the risk factors?

The risk factors for spondylolisthesis include a family history of back problems. People born with a defect in the pars interarticular of the spine (a condition called spondylolysis) have an increased risk of isthmic spondylolisthesis.

Other risk factors include a history of repetitive trauma or hyperextension of the lower back or lumbar spine.

Athletes such as gymnasts, weightlifters, and soccer linemen who have great forces applied to the spine during extension have a greater risk of developing isthmic spondylolisthesis.

What types of doctors treat spondylolisthesis?

Radiologists diagnose spondylolisthesis with X-rays, CT scans or MRIs.

Orthopedic surgeons, specialized neurosurgeons in the spine, physicians in physical medicine and rehabilitation, neurologists, internists, primary care providers and rheumatologists often treat spondylolisthesis.

Chiropractors and physiotherapists also frequently treat patients with spondylolisthesis.

Tests

It is difficult to know if you have spondylolisthesis because you may not have any symptoms or overwhelming pain; Most people do not.

Spondylolisthesis is usually discovered when it is tested for something else and the doctor notices the vertebrae slipped on an x-ray.

They will inject a special contrast medium into the area around the nerves, the nerves are in a sac, so the dye will get into that sac. Spondylolisthesis can cause it to walk abnormally, so the doctor may have to monitor it.

Skid qualifications

Using the lateral radiograph, your doctor will evaluate your spondylolisthesis. You will use the scale from grade I to grade V that describes how far your vertebra has slipped.

How do doctors diagnose spondylolisthesis?

In general, it is not possible to see visible signs of spondylolisthesis when examining a patient.

The diagnosis of spondylolisthesis is easily made by simple radiographs. A lateral X-ray (from the side) will show if one of the vertebrae has slid forward compared to the adjacent vertebrae.

Spondylolisthesis is classified according to the percentage of sliding of the vertebra compared to the neighboring vertebra.

If the patient has complaints of pain, numbness, tingling or weakness in the legs, additional studies may be requested. These symptoms can be caused by stenosis or narrowing of the space for the nerve roots of the legs.

A CT scan or magnetic resonance imaging can help identify nerve compression associated with spondylolisthesis.

Treatment

The initial treatment for spondylolisthesis is conservative and is based on the symptoms.

Conservative

Patients with symptomatic ishtmic anterolistesis are initially offered a conservative treatment consisting of activity modification, pharmacological intervention and a physiotherapy consultation.

A short rest period or avoiding activities such as lifting, leaning and athletics can help reduce symptoms.

Therapy

Physical therapy can assess and address postural and compensatory movement abnormalities.

For some patients with isthmic spondylolisthesis, they may benefit from a hyperextension orthopedic device (lumbosacral orthosis), but they should be used temporarily to prevent spinal muscle atrophy and loss of proprioception.

This extends the lumbar spine, bringing the two parts of the bone closer to the defect, and may allow healing. Application of heat and / or ice to reduce localized pain.

Exercises for spondylolisthesis are often incorporated into the treatment plan for these conditions for several reasons.

On the one hand, physical therapy focuses on strengthening and improving the range of movement of the back, abdomen and legs, as this can help these other muscle groups to take part of the stress that is normally placed on the spine vertebral

Spondylolisthesis treatment exercises can also be beneficial from the perspective of weight loss, since excess pounds increase stress on the back.

Medicines

Anti-inflammatory medications in combination with paracetamol (Tylenol) can be tested initially. If a severe radicular component is present, it can be considered a short treatment with oral steroids such as prednisone or methylprednisolone.

Home remedies for spondylolisthesis are similar to those for low back pain and include ice, heat, and over-the-counter pain relievers, such as acetaminophen and anti-inflammatory medications.

Epidural steroid injections, either interlaminar or transforaminal, performed under fluoroscopic guidance can help with severe radicular (leg) pain. To relieve the pain of the patient can inject lidocaine and steroids for a diagnostic study.

Surgical

For those whose symptoms do not improve with conservative treatment, surgery may be an option.

Degenerative anterolisthesis with spinal stenosis is one of the most common indications for spine surgery (usually a laminectomy) among older adults. Both minimally invasive and open surgical techniques are used to treat anterolisthesis.

This involves removing any scar tissue from the defect and placing some bone graft in the area followed by the placement of screws through the defect.

There is an increased risk of nerve injury when moving the vertebra to the normal position. The results and recovery after surgery are improved with the rehabilitation of physical therapy.

The surgeon may also recommend a spinal fusion made from the front of the spine at the same time.

Spondylolisthesis exercises for pain and back relief

After a thorough evaluation, your physiotherapist will be able to provide you with a personalized program of exercises at home to help decrease pain due to spondylolisthesis.

This program often includes lumbar flexion exercises, central stabilization exercises and exercises or stretches for the back, hamstrings and hips muscles.

Low-impact exercise such as biking or swimming is also recommended to promote healing and reduce pain.

Usually, doctors prescribe exercises to strengthen the abdomen and back muscles, and also to increase the flexibility of the joints, which helps prevent and rehabilitate the severe type of low back pain.

Maintaining daily activities with a tolerable limit can also help achieve a faster recovery in spondylolisthesis, rather than resting in bed. These are the best exercises for spondylolisthesis:

1. Pelvic tilt exercise

Lie on your back with knees bent and feet flat on the floor. Pull your belly button towards your spine and push the lower part of your back towards the floor, flattening your back. Hold for 15 seconds, and then relax. Repeat five to ten times.

2. Gluteal stretching exercise

Lie on your back with your knees bent. Lift one knee and gently pull it towards your chest for 10-15 seconds, and then relax. Repeat five to ten times for each side.

3. Bridge exercise

Lie on your back with both knees around 90 degrees. Then push the feet on the ground, squeeze the buttocks, and lift the hips off the floor until the shoulders, hips and knees are all in a straight line.

Hold it for about 5 seconds, and then slowly lower your hips down to the floor and rest for up to ten seconds. Repeat 10 times

4. Back stretch exercise

Lie on your back, hands on your head. Bend your knees and turn them slowly to the side, keeping your feet on the floor. Hold for 10 seconds. Repeat 3 times on each side.

5. Deep lunge exercise

Kneel on your knee, the other foot in front. Looking forward, raise the knee back. Hold for 5 seconds. Repeat 3 times on each side.

6. Winding exercise (partial)

Lie on your back with knees bent and feet flat on the floor. Do not press the neck or lower back against the floor. Next, squeeze the abdomen and fold it halfway, keeping the head aligned with the shoulders. Hold this for 5 seconds. Unroll to lie down. Repeat 3 sets of 10.

7. Knees to the chest

Lie on your back, bring both knees to your chest and then pull on your knees as much as possible. Hold for 10-20 seconds, return your legs to the floor. Do the exercise about 10 times. You can do this exercise with one or both legs once.

8. Side table exercise

Lie on your right / left side with your legs straight. Get comfortable with your right forearm so that your body forms a diagonal line.

Rest your left hand on your hip. Secure your abs and hold for 1 minute or 30 seconds. Make sure your hips and knees do not touch the floor.

9. Arm and leg exercise

Put on your hands and knees. Tighten the abdominals to harden the spine. When keeping your abdominal muscles firm, lift one arm and the other leg away from you.

Hold this position for 5 seconds. Slowly lower your arm and leg and alternate the sides. Do this 10 times on each side.