Spondylolisthesis of the lumbosacral spine - what is it?

The human spine is a complex system that works without failures as long as all its fragments are in order. But as soon as something changes, even slightly, there are consequences, the severity of which depends on the magnitude of the problem. Anthespondylolisthesis is a displacement of a vertebra. It all starts when one of the vertebrae becomes displaced in relation to the one below it, protruding towards the spinal cord. Why does this happen, and what needs to be done about this pathology.

Spinal anthespondylolisthesis - what is it?

Cervical spondylolisthesis - the overall picture

In most cases, the pathology forms in the area of ​​the fourth or fifth spine . The main cause of the disorder is spondylolysis, which refers to the splitting of the vertebral pedicle. The pedicle is the section that attaches the body of each vertebra to the facet joints.

Taking into account the severity of the patient’s condition, doctors identify four stages of the disorder, which are always accompanied by neurological pathologies.

Grade 5 spondylolisthesis is characterized by complete prolapse of the vertebra

Attention! Spondylolisthesis of the cervical spine in most cases is provoked by injuries, which, if insufficiently cured or with large-scale damage, gradually lead to complications in the form of spondylolysis. Its spread may take several years until the condition becomes apparent.

Why is the vertebra out of place?

How does a structural piece of the spine called a vertebra suddenly move out of place? The structure is strong, can withstand heavy loads, there must be a good reason for it to lose its integrity. The process begins with destruction of the intervertebral disc, but the reasons have not yet been established.

What are intervertebral discs

Important! Medicine does not know the root cause of anthespondylolisthesis; despite numerous studies, the etiology of the disease is not completely clear. In order to somehow classify pathology, it is divided into types according to provoking factors that can affect its occurrence.

Currently, there is no consensus regarding the causes of such a condition as anthespondylolisthesis.

There are two types of disease - acquired and congenital. According to the factors provoking the first type, pathology is divided into:

• real;
• false pathological;
• traumatic;
• paralytic;
• spondylolytic.

Most often, anthespondylolisthesis occurs in the fourth and fifth lumbar vertebrae. L4 shifts, protruding above L5, which protrudes above the sacral region.

If you want to learn in more detail how to treat displacement of the thoracic vertebrae, as well as consider the causes, symptoms and alternative treatment methods, you can read an article about this on our portal.

Compression symptoms are characteristic of anteospondylolisthesis of the L4-L5 vertebrae and occur due to pinched nerve roots and are expressed by severe pain in the lower back

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Why is this dangerous? Pathology in the L4 vertebra occurs due to compression of the nerves of the lower spinal cord; it can result in disability, but is not particularly widespread. Antespondylolisthesis of the L5 vertebra is the most common. It can also cause disability because the sciatic nerve is pinched and the legs can be paralyzed.

By the way. Why is the lower back the “risk zone”? The explanation is simple. The chest and the entire part of the vertebral arch passing along it are fixed more firmly than the mobile lower back. The cervical area, although it does not have a rigid rib frame, does not experience such global loads as the lower back.

Vertebral displacement forward

The maximum amount of pressure during any type of physical activity, and even when a person is simply walking or standing, occurs in the lumbar zone. The vertebrae can shift slightly in all departments, but only in the L4-S1 segment will the displacement be the largest and truly dangerous.

Classification and provocative factors

The pathology can be protracted or have an acute course. In its protracted form, it is caused by long-term diseases of the spine or diseases that are passed on to a person genetically. In acute cases, the cause of vertebral displacement is usually trauma, which gives immediate manifestation of symptoms.

Spondylolisthesis

By the way. One of the reasons for acquired displacement is called spondylolysis. It can be considered the main provoking factor, since it causes pathology in 67% of episodes of antespondylolisthesis.

Degree of severity depending on the depth of vertebral displacement

The disease is also classified into stable and unstable forms. When stable, the displacement remains unchanged, but when unstable, it appears or disappears if the patient changes body position.

Anthespondylolisthesis can be stable or unstable; if unstable, the vertebra may shift when the patient changes position

What exactly can trigger anthespondylolisthesis.

1. Congenital defect, pathology.
2. Vertebral tuberculosis and other degenerative diseases.
3. Increased traumatic susceptibility of the vertebrae.
4. The sacrum is located horizontally.
5. Degenerative metamorphoses began in the disc.
6. The processes of the articular fragments of the vertebra are deformed due to their underdevelopment, which leads to underdevelopment of the joints.
7. Any congenital pathology of the vertebrae can “trigger” displacement.
8. Sitting for long periods of time.
9. Lifting, carrying and bending over heavy objects.
10. Hereditary predisposition to spinal diseases.

Lifting weights is one of the reasons

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Risk factors and causes of pathology development

Doctors often examine patients with cervical spondylolisthesis, which began in childhood due to a fracture. Primary signs of this condition of spinal displacement appear only after adulthood , and sometimes after the age of 35-45 years. Usually the triggering factor is a sudden or systematic load on the shoulder girdle; loaders often suffer.

The process of spreading the arches of the spine in the cervical region occurs very slowly, sometimes over decades. It is this possibility that in some cases does not allow us to immediately identify the process of the disorder and carry out quick and conservative treatment.

In addition, the disease can be caused by dislocations, sudden movements of the head back , small children are especially susceptible, unsuccessful surgical intervention, which violates the correctness and integrity of the support of the discs. Sometimes spondylolisthesis starts in utero or is acquired during childbirth, when the umbilical cord fails to wrap around the baby’s neck.

Attention! Sometimes the disease is transmitted through hereditary lines. However, it is difficult to say exactly how long it will take for spondylolisthesis to manifest itself. If there have been cases of such a violation in the family, more attention should be paid to preventive measures.

Causes

The disease has been studied quite well, and among its causes are the following:

• congenital anomalies of the development of intervertebral joints and vertebral arches;
• previous back injuries;
• tumors, inflammatory processes in the spinal column;
• surgical interventions on the dorsal surfaces of the vertebrae;
• degenerative changes in the fourth lumbar vertebra are often observed with arthrosis of the spinal column, which is accompanied by instability of its segments;
• heavy physical labor, carrying heavy objects;
• sharp spasms of the back muscles;
• being in a forced position for a long time (bedridden patients);
• the provoking factor is sharp temperature fluctuations.

The disease most often develops in older people

The disease also develops in older people due to changes in anatomical and physiological characteristics (spinal canal stenosis, arthropathy). Uncontrolled loads on the back lead to deformation of the vertebrae, damage muscles and tissues, which can result in rupture of the ligamentous apparatus. Birth injuries play a certain role in etiopathogenesis. In some cases, the disease occurs due to the fault of doctors as a result of an unsuccessful operation.

Based on the leading etiological factors, scientists have compiled a classification of the disease:

• congenital antelisthesis - not so common, usually localized to the level of the fifth lumbar vertebra;
• traumatic – this form is characterized by a long and stable curvature of the spine;
• degenerative-destructive – observed in elderly people;
• surgical – caused by a medical error.

Consequences of the development of cervical spondylolisthesis

The consequences of the violation are quite varied and depend on which vertebra is displaced and how visible this displacement is.

Most often, patients encounter such problems:

• 
  Spondylolisthesis can lead to pinching of the nerve and vertebral artery; a noticeable decrease in the length of the cervical spine;

• pinched nerve and disruption of the bone marrow and brain;
• development of arterial hypertension;
• narrowing of the spinal tubules;
• disruption of the functioning of the organs of hearing and vision, sometimes in the absence of treatment, complete dysfunction of these systems occurs;
• the ear-nose-throat apparatus is often affected;
• the processes of memory and assimilation of information are disrupted, anesthesia may develop;
• Partial paralysis of the upper or lower extremities may develop.

Stages of development

Spondylolysis is almost invisible in the early stages and can be asymptomatic for a long time. The clinical picture largely depends on the stage of progression of the changes. There are four of them in total:

Retrolisthesis of the L4 vertebra - what is it?

1. Initial. There are no symptoms, the patient has virtually no idea about the presence of a defect in the body or abnormalities in the functioning of the spine. In rare cases, the patient complains of minor discomfort in the lumbar region. But it can easily be attributed to excessive fatigue.
2. Second stage. Patients report increased discomfort or pain after performing simple activities or physical activity. In rare cases, unpleasant symptoms are disturbing even at rest.
3. Third stage. The pain is present almost constantly and does not allow the person to relax or move normally. There are high chances of developing paralysis and impaired mobility, which significantly worsens the quality of life.
4. Fourth stage. The patient has a characteristic change in gait, body shape, and curvatures are visible to the naked eye. The pain becomes constant and does not allow normal movement.

At the last stage, a person becomes disabled because he is unable to care for himself or perform simple actions. If at this stage the patient does not receive proper treatment, the pathology progresses and the vertebra collapses. The sooner measures are taken to eliminate the cause, the less damage a person will receive from the pathology. Therefore, even minor manifestations of the disease cannot be ignored.

Symptoms and methods of diagnosing the disease

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The symptoms of the disease are for the most part similar to the consequences caused by spondylolisthesis . In addition to problems with blood pressure, dysfunction of the musculoskeletal system, visual and auditory systems, the patient faces severe pain and the inability to perform even minor physical work.

Often with spondylolisthesis there is a strong burning sensation , a feeling of heaviness and discomfort in the cervical spine.

Diagnosis of the disease occurs during an in-person examination and the appointment of radiography. During the second procedure, the specialist assesses how far the vertebral pedicles have moved apart and whether there is any pathological displacement. For a more accurate diagnosis, an examination using MRI, CT and radiography with a functional test will be prescribed.

Attention! If the patient has disorders such as osteochondrosis, osteoporosis, kyphosis, scoliosis and other dangerous processes in the spine, you should pay close attention to the cervical spine. Sometimes the patient may mistake the resulting discomfort and pain for these chronic pathologies, allowing spondylolisthesis to further affect the system.

Video: “Displacement of a vertebra in the cervical spine: what to do?”

About the disease

Sometimes antelisthesis is compared with spondylolisthesis, but the difference between these diseases is that in the first case the entire vertebra is displaced, and there is no non-fusion of the vertebral arch in the interarticular zone (spondylolysis). Most often, the disease occurs in women, the elderly and people with obvious (excessive) lordosis.

The disease is usually detected during diagnostic measures for lumbar osteochondrosis. The following dependence is noted: the lower the displacement is located, the greater its severity. Typically, the l2 vertebra shifts by 4 mm, with antelisthesis of the l3 vertebra - by 6 mm, antelisthesis of the l4 vertebra is characterized by a displacement of a whole centimeter.

Antelesthesis of the spine at level L5 is an exception, since the maximum shift of the body is six millimeters (the reason is the strong connection with the 1st vertebra of the sacrum). In addition to the lumbar region, the vertebrae of the cervical spine are quite often affected: antelisthesis of the c2 or c3 vertebra, antelisthesis of c4. Pain syndrome is the main subjective manifestation of the disease.

The diagnosis is confirmed by x-ray: the displaced vertebra looks like a “overhanging visor” on the picture.

Treatment of cervical spondylolisthesis

Drugs

When the spine is displaced, NSAIDs and painkillers are taken. When spondylolisthesis develops, the patient is prescribed painkillers and anti-inflammatory substances .

Usually, preference is given to non-steroidal medications, as they cause minimal side effects and are well tolerated by patients.

Usually medications such as Nimesulide, Diclofenac, Nise, Nimica, Aponil are prescribed.

These medications can be used in the form of tablets, injections and powder. The attending physician decides which form to use for a particular patient. They are usually used within 5-10 days.

Painkillers can also be used in the form of tablets and injections.

The most common of them are Ketanov, Nurofen, Mig, Ibuprofen and others. Painkillers are rarely used for more than five days.

Surgery

Surgery is usually prescribed only for congenital spondylolisthesis . Surgical treatment is also prescribed for serious injuries and falls from a height. To begin with, the surgeon will fix the cervical vertebrae and insert plates and pins to keep them in the desired position. If there were no complications after the operation, rehabilitation lasts six months.

Exercises, exercise therapy and massage

This type of therapy is the main way to cure spondylolisthesis and restore lost health . The exercise therapy complex is selected separately for each patient, since it is important to take into account other chronic diseases not only of the musculoskeletal system, but also of other systems.

Massage helps relieve excessive tension and pain. It should be performed with as gentle movements as possible, without putting pressure on the damaged area. Usually 10 sessions are prescribed every 3-5 months, taking into account the severity of the condition.

Exercises are especially useful for spondylolisthesis.

• To begin with, you need to sit up straight and turn your neck left and right. 10 turns are made in each direction.
• After the turns, bend forward and backward, also 10 times in each direction. This way you can relieve the spasm.
• Pressing the forehead onto the arms crossed in front.
• Raise your shoulders up, holding them in this position for 10 seconds. The manipulation is required to be repeated 5 times.

Treatment of spondylolisthesis at home is impossible, as it necessarily requires medical prescriptions and diagnostics . At home, the patient can only perform the exercises prescribed to him and avoid putting stress on the cervical spine.

Prevention of cervical spondylolisthesis

To prevent even minimal displacement of the spine, a number of mandatory recommendations must be followed.:

• 
  Pay attention to the recommendations on how to avoid the development of spondylolisthesis; do not put heavy loads on the spine;

• Strength training is especially dangerous during which the technique of performing the exercise is impaired;
• frequent sitting at a table, during which posture is not maintained;
• be sure to monitor your posture while walking and standing;
• be sure to take breaks if necessary to perform sedentary work or activities associated with constant stress on the musculoskeletal system;
• try to carry less heavy things, this rule especially applies to children and women;
• Injury to the spine and neck should not be allowed;
• if there are problems with the musculoskeletal system, it is necessary to prevent the exacerbation of these pathologies;
• systematically perform exercises to strengthen the muscles of the neck and back.

Attention! Sport is a prerequisite for the prevention of spondylolisthesis. But it is important to ensure the accuracy of the technique, the absence of overload and excessive fatigue, which can cause injuries and inflammation, which will subsequently lead to displacement of the cervical vertebral discs.

Features of treatment

Treatment can be multifaceted and covers many areas, combining them into a single complex.

Conservative therapy

The traditional and most common method of treating antespondylolisthesis. It gives a 100% effect in cases of disease of degrees 1 and 2, that is, until the vertebral body is displaced by more than half. The classic drug therapy regimen is as follows.

1. Taking non-steroids designed to relieve the body of inflammation and pain. Most often prescribed are Ibuprofen, Ketorolac and other drugs of these groups.

   
   "Ketorolac"

2. Using physical therapy to help strengthen the abdominal muscles and limit the mobility of the injured spinal area.
3. Constantly wearing an orthopedic corset, which will prevent the vertebra from moving further, fixing its position.
4. If drug therapy does not help to completely cope with the pain, epidural anesthesia is a block injection (course).
5. Therapeutic physical education, a specially selected gymnastic complex.
6. Supportive auxiliary treatment with folk remedies.

One of the most effective physiotherapeutic procedures for degenerative anthespondylolisthesis is electrophoresis with dimexide.

Regarding medications, everything is simple - they help if the stage is not very advanced. One of the most effective physical procedures for many problems with the spine is electrophoresis. When diagnosed with degenerative anthespondylolisthesis, it is done with dimexide. Thus, the drug can be delivered deep under the skin and maintain its concentration in the tissues high for seven days.

By the way. Diadynamic currents and the use of therapeutic mud baths effectively improve blood circulation and allow regeneration of the spinal area damaged by anthespondylolisthesis.

Mud therapy aims to use mud of various origins

If drug therapy does not produce results or the result is unsatisfactory, most likely the degree of the disease is higher than the second. In this case, an epidural block is performed. Novocaine is delivered directly to the epidural space by injection. The procedure is very effective, completely relieves pain, and can be carried out in three courses throughout the year.

Physiotherapeutic devices

Physical exercise

It is worth paying special attention to them, since the selected complex of physical therapy necessarily complements any conservative treatment. Physical exercise is necessary to strengthen the abdominal and back muscles.

Exercises to strengthen the muscles of the back and abdomen

If you do them regularly, the muscle corset will maintain tone, which will allow it to support the entire spine in the correct position. Although the complex is always selected and prescribed individually, depending on the stage and characteristics of the patient and the disease, there are a number of general exercises indicated for anthespondylolisthesis.

Recovery prognosis

It is clear that displacement of the vertebrae is always a dangerous process that can provoke many pathologies and lead to disability. Particularly serious are conditions in which the blood supply to the brain and central nervous system is disrupted. But provided that the pathology is diagnosed in a timely manner and appropriate treatment is prescribed, it is possible to quickly eliminate the disease and remove the consequences of its manifestation.

An important role is also played by which vertebra was displaced, as well as the number of damaged segments. The more discs are displaced, the later the disease is detected, the more difficult it is to return the patient to his former life. It is especially difficult for patients to recover after surgical interventions.

Diagnostics

To make a diagnosis, the patient will need to see a spine specialist or orthopedist at a local clinic. The results of an X-ray examination will help determine characteristic changes. It is prescribed after a visual examination. The following factors allow one to suspect pathology:

• The presence of a depression or protrusion in the area of ​​the 5th lumbar vertebra.
• Retraction syndrome, indicating displacement of a bone segment.
• Excessive muscle tension in the affected area.
• The presence of Turner's symptom (pathological lordosis or kyphosis).
• Skin folds or protrusion of the sternum, shortening of the lower back.
• Change in gait, feet crossed, knee joints bent.

To clarify the diagnosis, an x-ray is prescribed in the supine position. The resulting image in oblique and standard projection allows us to determine the presence of anomalies or other complex changes in bone tissue. In addition, computed tomography is also prescribed. It allows you to view the defect in horizontal sections. But due to the high cost of the procedure, not all patients undergo it.