Spondylolisthesis (spinal listhesis, vertebral listhesis) is a displacement (slipping) of one of the vertebrae relative to the underlying one forward (anterolisthesis) or backward (retrolisthesis). Spondylolisthesis most often occurs in the cervical and lumbar spine, which have greater mobility and experience the greatest vertical load than the thoracic spine. Depending on the displacement of the vertebral bodies relative to each other, five degrees of spondylolisthesis are distinguished:
- I degree - displacement of the body of the overlying vertebra up to 25% relative to the underlying vertebra;
- II degree - displacement up to 50%;
- III degree – displacement up to 75%;
- IV degree – up to 100%;
- V degree (spondyloptosis) - complete displacement of the body of the overlying vertebra in relation to the underlying one.
There is also a distinction between stable and unstable spondylolisthesis. With stable spondylolisthesis, the posture adopted by a person does not affect the displacement of the vertebrae, but when the vertebral bodies are displaced depending on the position of the person’s body, we can talk about unstable spondylolisthesis.
Types and stages of spondylolisthesis
There are several types of listhesis, depending on which direction the upper vertebra is displaced in relation to the lower one:
- anthespondylolisthesis – forward displacement (“inside” the body),
- retrospondylolisthesis – sliding of a vertebra backwards (outwards),
- laterospondylolisthesis - displacement to the right or left side.
Due to the structure of the spine, not all parts are equally susceptible to this disease. Cervical listhesis is relatively rare and is characterized by displacement of the middle vertebrae. In the thoracic region, this disease practically does not occur due to a fairly firmly fixed structure - the chest. The lumbar spine is most susceptible to spondylolisthesis. Due to incorrect posture and physical activity, the vertebrae literally “slide” into the body, which is also facilitated by the physiological lordosis of this section. The sacral area is stable, but the coccyx is also subject to displacement, but mainly due to injury.
Degrees of vertebral listhesis
The degree of listhesis depends on how many degrees of displacement occurs. The higher this parameter, the more serious the danger to the patient’s health.
Currently, the following degrees of vertebral listhesis are accepted in the medical classification:
- 1st degree – deviation from the central axis by 25%;
- 2nd degree – deviation by 50%;
- 3rd degree – displacement up to 75%;
- Grade 4 – complete displacement or slipping of the vertebra.
Only the first and second degrees can be successfully treated with conservative methods. In the third, a planned surgical operation is required to restore the fixing ability of the ligamentous and tendon apparatus. In the fourth degree, emergency surgery is required to restore the patency of the spinal canal.
Causes of spondylolisthesis
Most often, the disease develops in patients with pathologies of the musculoskeletal system or in healthy people due to serious injury. Depending on the cause that provoked listhesis, six types of the disease are distinguished.
- Degenerative (false). It usually develops against the background of osteochondrosis or arthritis and most often affects the lumbar region. Women are affected three times more often than men. The disease develops after 40 years of age, however, cases of early spondylolisthesis are becoming increasingly common (including due to sedentary work).
- Traumatic. It can develop due to regular overload (for example, lifting heavy objects with improper weight distribution) or sudden trauma to the spine (falling on your back on an uneven surface).
- Isthymic. It develops due to insufficiency (congenital or acquired) of the interarticular part of the vertebra and is often provoked by physical overstrain.
- Dysplastic. The cause is a congenital defect of the facet joints of the vertebrae. Affects the lumbar, less commonly, sacral vertebrae.
- Pathological. Develops due to a defect and deformation of the bone, often against the background of tumors.
- Post-surgical. May form after spinal surgery.
There is also stable listhesis - the displaced vertebra is always in its displaced state, and unstable, when the vertebrae are displaced in different directions, depending on the change in the person’s posture.
Content:
- Degrees of spondylolisthesis
- Symptoms of spondylolisthesis
- Diagnosis of spondylolisthesis
- The need for surgical intervention
- Rehabilitation after surgery
As you know, there are several types of displacement, or spondylolisthesis. They are classified according to etiology - the cause of the disease, namely
- Congenital, isthmic, true
- Degenerative, secondary, false
- Traumatic
- Neoplastic and some other rare forms
Symptoms of spondylolisthesis
The main complaints with listhesis are aching pain in the affected area, aggravated by physical activity or being in one position for a long time, limited movement; it is necessary to maintain an even spine through “effort of will.” However, depending on which vertebra is displaced, i.e. which part of the spinal cord is under pressure, specific symptoms may develop, often misdiagnosed as a separate disease.
A little about spondylolisthesis
With this pathology, in one of the parts of the spine there is a displacement of neighboring vertebrae relative to each other in the horizontal plane . Usually the upper one is displaced relative to the one located below. Moreover, the vertebrae can move both backward and forward. There are also lateral displacements.
Spondylolisthesis of the spine - vertebral listhesis
The most common form of pathology is spondylolisthesis or listhesis of the lumbosacral region, since it is this part of the spinal column that experiences the greatest load every day.
Stages of formation of spondylolisthesis
Cervical region
I vertebra: Neuroses, insomnia, dizziness, memory impairment, hypertension, runny nose.
II vertebra: Ear pain, hearing impairment, squint, dizziness and fainting, allergies.
III vertebra: Neuralgia, neuritis, acne.
IV vertebra: Qatar of the respiratory tract, adenoiditis.
V vertebra: All kinds of ENT diseases, tonsillitis, laryngitis.
VI vertebra: Tonsillitis, whooping cough, stiff neck.
VII vertebra: Diseases of the thyroid gland, inflammation of the elbow joint (bursitis).
Thoracic region
I vertebra: Asthma, shortness of breath, cough.
II vertebra: All kinds of cardiac disorders.
III vertebra: Bronchitis, pleurisy, pneumonia.
IV vertebra: Cholecystitis, herpes zoster.
V vertebra: Circulatory disorders, hypotension and anemia, liver disease, arthritis.
VI vertebra: Various stomach diseases: gastritis, heartburn, ulcers, etc.
VII vertebra: Duodenitis, pancreatitis.
VIII vertebra: Disturbances in the functioning of the spleen.
IX vertebra: Impaired functioning of the adrenal glands.
X vertebra: Various kidney diseases
XI vertebra: Skin diseases: eczema, acne, furunculosis.
XII vertebra: Pain in the intestines, rheumatism, infertility.
Lumbosacral region
I vertebra: Problems with the colon, stool disorders.
II vertebra: Acidosis, appendicitis, cramps in the thigh muscles.
III vertebra: Menstrual irregularities, miscarriage, bladder disease, impotence.
IV vertebra: Painful urination, pinched sciatic nerve, lower back pain.
V vertebra: Cramps in the lower leg, swelling of the ankles, paresthesia in the legs.
Listhesis of the sacrum leads to curvature of the entire spine, and of the coccyx - to hemorrhoids and pain in the coccyx.
Diagnosis of spondylolisthesis
As with any back pain, you should first contact a neurologist. You can also consult a vertebroneurologist, neurosurgeon or orthopedist.
For an accurate diagnosis, an X-ray examination is required in several projections, sometimes with tilting/extension of the spine (functional tests). This is the most informative and fastest way to determine the degree and direction of vertebral displacement.
The Aximed Neurology Clinic also uses additional diagnostic methods: various types of tomography, electroneuromyography, and laboratory tests. The patient is consulted by a neurologist and, if necessary, an orthopedist-traumatologist. And during the treatment, you are accompanied by a physical therapy instructor and a kinesiotherapist.
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.
Conservative treatment
The main measures for the conservative treatment of listhesis are aimed at:
- pain relief with painkillers of various effects,
- treatment of the inflammatory process in cartilage, which often accompanies listhesis,
- restoration of deteriorating cartilage with chondroprotectors,
- muscle relaxation with muscle relaxants and massage,
- strengthening the muscle corset (physical therapy plays a major role in spondylosis),
- Manual therapy can partially or completely return a displaced vertebra to its place.
Clinical case 1
Patient Z., whose isthmic, also known as congenital or true listhesis, was combined with discitis, inflammation of the disc.
The image clearly shows the zone of non-fusion (zigzag with a fountain pen).
Her photo, the intervertebral disc is almost completely absent, there is a vacuum effect, the vertebrae are sclerotic, all this did not allow us to carry out a des cage.
Intraoperative radiograph demonstrating the displacement of the vertebrae, pins determining the position of the screws in perspective.
Screws were inserted, reduction was performed, i.e. reduction of listhesis and its rigid fixation. The PLATINUM transpedicular system from the Titanmed company was used.
Control CT scans after surgery demonstrate reduction of listhesis, correct placement of fixators, and adequacy of decompression.
After the operation, the patient “rose to her feet” 3 days later, after regression of pain, she walked a lot around the department and was discharged with a good functional result.
Surgery
Severe cases may require surgery. The method consists in immovably connecting two adjacent vertebrae using special plates and removing the deformed parts of the vertebra. On the one hand, this allows you to fix the spine, on the other hand, it limits its mobility. In addition, with pathological weakness of the musculoskeletal system, the “prolapsed” vertebra can now pull the healthy one along with it.
Regardless of the stage at which spondylolisthesis is diagnosed, the spine now requires rehabilitation measures at least twice a year (or even more often).