Retrolisthesis of the l2-l5 vertebra: what is it, causes, symptoms and treatment

Vertebral retrolisthesis is a pathological condition of the bone element of the ridge, which is manifested by severe pain and numbness of the limbs. The segment moves backward, which also affects the work of the back muscles. Appears mainly in the cervical (c3–c5) and lumbar (14–15), the thoracic region is practically not affected, as it has minimal mobility. The more vertebrae have changed their normal position, the more characteristic the clinical picture is and the more severe the patient’s condition.

Brief description of the disease

Retrolisthesis is a backward displacement of the vertebrae relative to the axis of the spine and the position of neighboring elements. Deformities of this type are recorded mainly in the lumbar region, since it is the most mobile and bears the main load. This pathological condition occurs at any age, but it is diagnosed mainly in older people.

In children, retrolisthesis can begin after a serious injury, for example, ligament rupture, compression fracture, excessive sports stress, or an accident. In this case, the shift of the bone element narrows the spinal canal itself, which negatively affects the functioning of all systems, as it affects the spinal cord and nerve endings. The patient has trophic and vascular disorders, muscle-tonic syndrome. Without timely treatment, there is a high probability of developing paralysis and disability. Retrolisthesis has its own classification, which allows the specialist to correctly select the treatment method.

Pathology comes in 4 different stages, depending on the severity of the displacement:

1st degree – shift by 25%.
2 degrees – shift by 26–49%.
3 degrees – shift by 50–74%.
4 degrees – shift by 75–100%.

A patient who does not see a doctor for a long time only worsens the situation, since the displacement process only progresses, gradually affecting the functioning of the internal organs. The percentage of shift of the bone element is determined by taking an x-ray. It is this that allows an accurate diagnosis to be made.

Bruises, fractures and cracks are the main prerequisites for the development of the disease

Prerequisites for the appearance of the disease

Retrolisthesis appears in the l5 vertebra most often, which is caused by compression fractures, deformation processes or any mechanical stress. The main causes of this pathology are:

Tears of the ligaments that hold the spine in its natural position.
Degenerative processes in intervertebral discs that have not been cured.
Excessive load on the spine due to professional or sports activities (loaders, circus performers, gymnasts, construction workers).
Back injuries caused by a fall or blow without proper medical treatment.
Genetic predisposition.
Age-related changes in the human body.
The presence of malignant tumors in adjacent tissues.
Weakened muscular corset of the spinal column.

The disease can be provoked by any of the described factors, but the situation is aggravated by the lack of correct treatment, an attempt to numb the pain with painkillers, as well as independent “repositioning” of the spine.

Causes

A spinal segment consists of two adjacent vertebrae, which are connected by facet joints, an intervertebral disc and a musculo-ligamentous apparatus. Thanks to its anatomically correct structure, the spinal column is capable of performing physiological movements without excessive hyperextension or twisting of the vertebrae relative to each other. Exposure to unfavorable factors leads to disruption of the correct relationship between the bodies, arches and processes of the vertebrae, which causes their displacement and disruption of the motor activity of the spinal column. The pathology leads to a narrowing of the spinal canal, pinching of the neurovascular bundles, and a defect in the musculo-ligamentous apparatus.

The most common causes leading to retrospondylolisthesis include:

degenerative-dystrophic diseases of the spine (osteochondrosis, spondylosis);
primary tumors or metastases in the vertebrae;
acute injury of the spinal column (fracture of processes and arches);
chronic microtraumas (isthmic spondylolisthesis) as a result of the formation of a defect between the vertebral body and the vertebral arch;
poor development of the muscular corset of the back.

Vertebral displacement by severity

The isthmic form of the disease often develops in professional athletes with excessive stretching and hyperextension of the spinal trunk during training. The risk group for the occurrence of pathology includes sports such as gymnastics, weightlifting, rugby, shot throwing and others.

Symptoms

The disease manifests itself in different ways, depending on the location of the problem and the severity. Many patients complain of back pain and loss of sensation in the extremities, but there may be other associated symptoms.

Ridge Division	Vertebrae numbers	Symptoms
Cervical	s1, s2, s3, s4, s5	- Severe pain in the affected area. - Noise in ears. - Headaches, migraines. - Nausea and dizziness. - Double vision, appearance of "floaters". - Blood pressure surges.
Chest	D1-D12	- Attacks of suffocation, constant shortness of breath. - Backache. - Cough and chest cramps. — Disorders of the gastrointestinal tract (ulcer, pancreatitis, cholecystitis). - Renal colic or discomfort in the kidneys.
Lumbar	L1-L5	- Severe attacks of pain in the lower back. - Numbness in the legs and problems with walking. — Dysfunction of the bladder and pelvic organs. - Problems with bowel movements.

Retrolisthesis of the l4 vertebra is similar in symptoms to a number of other diseases of the musculoskeletal system, so it is extremely important for the doctor to differentiate it and prescribe the correct treatment tactics. The pathology is dangerous, and therefore self-medication is unacceptable.

Important! If a vertebral displacement is diagnosed in a conscript, he is exempt from military service.

Retrolisthesis differs from other problems with the musculoskeletal system in the severity of its course. The level of vertebral slippage is much higher, and this can lead to serious complications. Severe pain is accompanied by a shift in the 15th segment, and it is the easiest to identify. The most dangerous is the displacement of the 14th vertebra, and it is pronounced. Retrolisthesis l2 is easier to tolerate, but also requires choosing the correct treatment.

MRI is one of the effective diagnostic methods

Types and symptoms of L5-S1 protrusion

The intervertebral disc has a close to ellipsoidal shape. On one side (posterior), it, together with the vertebral bodies, forms the spinal canal, where the spinal roots that form the cauda equina pass at the level of L5-S1. On the other side (front) they adjoin the soft tissues bordering the pelvic organs.

Therefore, anterior and building protrusions L5-S1 are distinguished. The former do not pose a serious danger, since the pressure they exert on surrounding organs is not enough to cause severe pathological changes to develop. The latter, on the contrary, are fraught with serious complications and require the earliest possible diagnosis and initiation of treatment.

Posterior or dorsal protrusions can compress the nerve fibers of the cauda equina, which will lead not only to acute, shooting pain, but also to the development of radicular syndrome. Therefore, if initially L5-S1 protrusion can only manifest itself as frequent or constant aching pain in the lower back and sacrum, which tends to intensify after prolonged walking, sitting or doing physical work and goes away after rest, then over time its manifestations can completely deprive a person of his ability to work.

Signs of advanced protrusion requiring immediate treatment are:

pain comparable to an electric shock, originating in the lumbar region and radiating to the middle part of the buttock, the back and outer lateral surface of the thigh and lower leg, as well as the foot, especially the little toe;
disturbances in the sensitivity of these areas of the body, which is manifested by numbness of the skin, the appearance of goosebumps, changes in the perception of hot and cold, pain even with light touches, etc.;
changes in leg mobility, muscle weakness with gradual subsequent hypotrophy, i.e., a decrease in volume, which leads to changes in gait, lameness, tucking of the foot and other disorders.

If such signs are present, it is said that the L5-S1 protrusion provoked the development of radicular syndrome, that is, it pinched the spinal root passing at the level of this spinal motion segment. If measures are not taken when radicular syndrome appears, the progressive disease can lead to paralysis and disability.

In this case, the symptoms of radicular syndrome can appear simultaneously on both legs and buttocks, or only on one side of the body, or in an intermittent manner. This directly depends on in which segment of the posterior surface of the L5-S1 intervertebral disc the protrusion has formed.

If the protrusion is located clearly in the center of the spinal canal (median protrusion L5-S1), it can simultaneously infringe on both spinal roots of this area. Therefore, violations will be observed on both sides simultaneously or alternately. If the protrusion is shifted to the left or right, we speak of its paramedian location. Then the symptoms will be observed from the corresponding half of the body.

If the radicular syndrome manifests itself very clearly and little time has passed from the appearance of the first discomfort to its development, this indicates the presence of foraminal protrusion. In this case, it is located in a narrow hole formed by the vertebral arches, through which the spinal root passes. Therefore, such a protrusion, even at a very small size, can provoke severe impairments of mobility, sensitivity and pain on one side of the body.

Sometimes diffuse protrusions occur. This term refers to protrusion of the fibrous ring over the entire area, which is fraught with the most severe symptoms.

Diagnostics

Retrolisthesis of the l3 vertebra or any other location is impossible to determine by eye. Although at the initial examination the doctor conducts a visual examination, interview the patient and study his medical history. But the following studies will help make an accurate diagnosis:

What is vertebral antelisthesis

General blood and urine analysis. To assess the general condition of the body, identify inflammatory processes and disruption of internal organs.
X-ray. Diagnosis of the disease itself, the degree of displacement and the presence of osteophytes.
MRI. Determining the presence of damage to nerve endings, the general condition of the spinal cord, ligaments and muscle tissue.
Electroneuromyography. Identification of the degree of damage to nerve fibers, as well as assessment of their general condition.

Diagnostic techniques make it possible to determine any characteristic changes in the spine. Pictures are most often taken only of those areas where pain is most characteristic. But sometimes you need to examine your entire back.

In the case of age-related changes in the body, retrolisthesis will be staircase, that is, gradually rounding the entire back, thereby making a person’s height smaller. It occurs mainly in people over 60 years of age. The doctor may suspect it already at the first examination.

What is L5-S1 disc protrusion and why does it occur?

Protrusion is the deformation of a disc with the formation of a protrusion in one direction or another. As a rule, this is a direct consequence of the lack of treatment for osteochondrosis, i.e., the initial stage of degenerative changes in the intervertebral disc. Previously, osteochondrosis was considered an age-related disease, but in recent years its significant “rejuvenation” has been observed. In most cases, this is due to a sedentary lifestyle and sedentary work.

Today, osteochondrosis and L5-S1 disc protrusion occur even in adolescents.

The reasons for the early occurrence of degenerative-dystrophic changes in the intervertebral discs are the increased loads placed on them. Since it is the lumbosacral spine that bears the greatest load in everyday activities, the discs located between its vertebrae are much more likely than others to suffer from osteochondrosis and protrusions. Moreover, the leader in the frequency of occurrence of deformities is the L5-S1 disc.

The vertebrae, and therefore the discs of the lumbar spine, are distinguished by their greatest width, the value of which exceeds even their height. This is directly related to the need to compensate for high loads.

Normally, the intervertebral discs are slightly abraded with every human movement, but then quickly restored due to the continuous diffuse supply of chondroitin, glucosamine and other biologically active compounds into them. But under the influence of excessive loads, the balance between these processes is disrupted for the worse, which leads to the early onset of degenerative-dystrophic changes in cartilage tissue.

This usually results from:

the presence of excess weight, even a slight one, since each extra kilogram greatly increases the load on the lumbosacral spine and the L5-S1 disc in particular;
sedentary work, sedentary lifestyle, since static loads can be even more destructive to cartilage tissue than active physical work;
excessive physical activity, especially related to heavy lifting;
poor posture, the habit of slouching or curvature of the spine, which leads to uneven distribution of the load.

Various metabolic disorders, especially diabetes mellitus, can aggravate and accelerate the process of destruction of intervertebral discs.

As a result of these factors, the nutritional process of cartilage tissue is disrupted, which is why it cannot be restored correctly and in a timely manner. Against this background, the level of hydration of the intervertebral disc decreases, but it consists of 80% water. Therefore, the slightest changes lead to a decrease in the elasticity of the numerous fibers of the fibrous ring surrounding its internal contents.

As a result, they can no longer withstand the high loads placed on them and evenly stretch and then shrink. Therefore, over time, microscopic cracks form in the fibers of the annulus fibrosus. They gradually increase, which is aggravated by increasing pressure inside the nucleus pulposus (the internal contents of the disc), since the cartilage is excessively compressed by the L5 and S1 vertebrae.

Sooner or later, the fibrous ring cannot stand it and becomes deformed, that is, it protrudes in the most vulnerable place. Thus, a protrusion of L5-S1 is formed. All this is accompanied by an inflammatory process and chronic pain of varying degrees of intensity. In this case, the outer shell of the disc still retains its integrity, but the bulging part can compress the surrounding anatomical structures, which will certainly make itself felt.

If the pathological process is not intervened at this stage, the L5-S1 protrusion will increase in size, increasing the risk of compression of surrounding tissues, blood vessels and nerve structures. Ultimately, the weakened fibers of the fibrous ring will not be able to withstand it and will finally rupture, as a result of which the nucleus pulposus, equalizing the pressure inside the disc, will leak out. Thus, the protrusion is transformed into an intervertebral hernia of L5-S1.

Due to the fact that during pregnancy the load on a woman’s body doubles, it is very important to put the spine in order. Our clinic has developed and prepared a special program of comprehensive examination and treatment for pregnant women and those planning pregnancy.

Features of treatment

Before starting treatment, a comprehensive diagnosis is carried out, the degree of displacement is determined, as well as the main factors that could provoke the pathology. If retrolisthesis is a consequence of another disease, then first of all, therapy is aimed at eliminating the root cause.

Treatment of the cervical vertebrae or lumbar spine is practically no different, as it includes taking medications, physiotherapy and therapeutic exercises. It is the complex effect that makes it possible to obtain stable remission and slow down the pathological process.

Conservative treatment

Medications are prescribed at an early stage of treatment, when the patient complains of acute pain and other neurological abnormalities. Therapy is predominantly symptomatic and is aimed at relieving unpleasant symptoms, as well as suppressing the inflammatory process, and improving overall well-being.

The doctor prescribes medications from the following pharmaceutical groups:

Painkillers (“Analgin”, “Solpadeine”, “Ketonal”). They suppress the manifestation of severe pain, which many patients cannot endure for long. They are used in the form of tablets or injections in particularly severe cases.
Non-steroidal anti-inflammatory drugs (Baralgin, Diclofenac, Ibuprofen). They relieve the inflammatory process and improve overall well-being, further suppressing pain in the affected area.
Muscle relaxants (Sirdalud, Mydocalm, Baclofen). Recommended in tablets or capsules. Aimed at reducing pain and suppressing spasms, relieving blockage or tightness in the lower back.
Ointments and gels for local action (“Voltaren”, “Amelotex-gel”, “Diclofenac”). They penetrate the skin and suppress the inflammatory process, while the active substances minimally enter the bloodstream. Used in the active stage.
Multivitamins (“Milgamma”, “Neurovitan”, “Neurobeks Neo”). This is an essential component in the treatment of back pathologies, since vitamin B is indispensable when starting the regeneration of affected areas and helps restore the nervous structure.

Conservative treatment of the third lumbar vertebra involves bed rest to minimize the load on the affected area. In addition, the doctor may prescribe wearing an orthopedic corset, visiting a chiropractor, or spinal traction. Carrying out any procedures or unplanned effects on the ridge without the consent of the attending physician is strictly prohibited.

Physiotherapeutic procedures complement the main complex of treatment for retrolisthesis

Physiotherapeutic procedures

When the acute period is stopped, the doctor can prescribe different types of physiotherapeutic procedures to treat retrolisthesis of the 5th vertebra. The main ones are:

Turpentine or pearl baths. They have healing properties and heal the entire body. This hydrotherapy relieves pain and improves blood circulation in the affected area, relaxes the muscle structure.
Electrophoresis. Used by both adults and children. By moving particles through the action of an electrical impulse, it delivers the medicine directly to the site of the lesion. It is always used as prescribed by a doctor, taking into account the individual characteristics of the body.
Acupuncture. It should only be entrusted to specialists experienced in this field, who know the location of acupuncture points and can influence them using needles with rounded tips. Discomfort during the procedure is minimal, while one session can trigger the body's defenses and enhance tissue regeneration.
Hirudotherapy. It is carried out using leeches. An unconventional method of treatment is used for many diseases of the musculoskeletal system. But due to the presence of a large number of contraindications, it is not applicable to all patients.
Ridge extension. Therapeutic practice is aimed at returning the spine to its natural position. It can be dry or underwater, the latter option involves partially immersing the patient in water.

Various types of therapy are aimed at anesthetizing the affected area, eliminating the defect, increasing the effectiveness of prescribed medications and strengthening the back muscle corset. Carrying heavy objects or sleeping on a soft sofa is also prohibited; a hard shield should be installed under the mattress. It will allow the spine to take the correct position during sleep.

Massotherapy

To improve blood circulation in soft tissues, it is also recommended to visit a therapeutic massage room. The specialist individually selects the technique, as well as the intensity of the impact, based on the severity of the lesion. The main positive effects of the sessions are:

Normalization of the movement of all biological fluids (blood, lymph).
Nutrition of tissues with necessary beneficial minerals and trace elements.
Regeneration of damaged areas.
Prevention of colds or complications.
Improvement of psycho-emotional background.

The duration is prescribed by the attending physician, depending on the patient’s well-being. In the later stages, visiting a massage room is not recommended due to the insignificant effect. Before carrying out the treatment, it is recommended to determine the pain threshold, this will reduce discomfort and allow you to get maximum benefit. Power techniques are not used, the emphasis is mainly on pulling.

Physiotherapy

Retrolisthesis cannot be slowed down if the patient neglects physical therapy (PT). Such gymnastics is aimed at improving well-being, increasing the quality of life, and returning the spine to its normal state. Exercises are selected individually depending on the patient’s age and the presence of concomitant diseases. Here are some useful exercises:

Lie on your back on the floor, place a small bolster or pillow under your lower back. Straighten your legs, place your arms along your body. When you raise your arms up and place them behind your head, turn your feet and pull your fingers towards you. The spine at this moment should stretch as much as possible. Do 5-6 approaches.
Lie on your stomach and fold your arms in front of you, bending them at the elbows. Place the forehead on the hands. As you inhale, raise your arms one by one, bending your feet. As you exhale, return to the starting position. Repeat 5 times for each side.
Lie on your stomach, legs tightly closed. Place your hands in front of you, place your head on your hands. As you inhale, lift it a little, spread your arms to the sides, trying to touch your shoulder blades. The legs are closed all the time. Stay in this position for 60 seconds.

Physical therapy for the diagnosis of retrolisthesis is a mandatory measure aimed at restoring damaged tissues. Due to the regularity of exposure, the result will not be long in coming. Muscle structures will become more mobile, pain will be relieved, and the spine will return to its natural position.

Sanatorium treatment

All diseases associated with the functioning of the musculoskeletal system require complex treatment, which includes sanatorium accommodation. A large number of rehabilitation measures are used there to help restore the muscle corset and improve metabolic processes in the body. The specialized institution is selected individually, depending on the proposed recovery programs.

Surgical operations

Retrolisthesis of the 4th vertebra is especially dangerous at stages 3 and 4. Therefore, for many patients, if the conservative approach is ineffective, surgical intervention may be recommended. The main indications for this are increasing compression, the appearance of instability of individual elements of the ridge, as well as the rapid progression of the disease.

In some cases, only surgery can restore the natural position of the spine.

The main objectives of the operation are to eliminate the displacement and return the spine to its natural position. The process uses bioinert stabilizing plates, screws and implants to stabilize the vertebrae. This allows the patient to effectively relieve pain and return the natural position of the ridge.

Preventive actions

Preventing retroolisthesis is much easier than curing it or eliminating all its consequences. Properly organized prevention will protect against any destructive processes in the body, strengthen the back and the body as a whole. To do this, you must follow a number of simple rules:

Reduce the number of working hours at the computer to a minimum. Every 2-3 hours of work, take a break with a warm-up of 15 minutes.
Exercise regularly, exercise or sign up for swimming.
Do not carry heavy objects on one side, do not move furniture unless absolutely necessary.
Properly organize physical work and provide back protection with a special belt.
Eat properly and regularly, enriching your diet with nutrients and minerals.
Visit a massage therapist for preventive purposes.

Such preventive measures will help prevent displacement of the vertebrae and protect the back from deformation. They strengthen the muscle corset and keep the body in good shape, regardless of age.

Retrolisthesis is a dangerous disease characterized by backward displacement of the vertebrae. This occurs as a result of injury or complications of degenerative processes in the intervertebral disc. It is important to detect it in the early stages in order to take all necessary measures to relieve unpleasant symptoms and exclude the development of neurological abnormalities. In advanced stages, paralysis and disability of the patient are possible. Therefore, the use of traditional methods without consulting a doctor or self-medication is unacceptable.