Center for Neurosurgery Dr. A.N. Baklanova successfully treats all types of spinal diseases, including vertebral displacement (spondylolisthesis). We will answer all your questions by phone: +7 (499) 746 - 99 - 50. You can also ask a question by filling out the request form below.
Vertebral displacement (spondylolisthesis) is a displacement of a vertebral body relative to another with a deviation of the spinal axis. This disorder occurs quite often in middle-aged and elderly people. When displaced, irritation of the nerve roots occurs, which causes back pain and stiffness. Spondylolisthesis varies according to the vectors of vertebral displacement. When the displacement is directed backwards, it is retrolisthesis; if the vertebra moves forward, it is vetrolisthesis. There are also more complex deformation changes in the spinal column. Late diagnosis and delayed treatment of the disease leads to serious consequences.
In colloquial speech you can hear: “displacement of vertebral discs”, “displacement of spinal discs”, “a disc has slipped out in the spine”, “a disc has popped out in the spine or back”, “displacement of intervertebral discs” and other options. All of them are not correct. Only the vertebrae can move.
Why does vertebral displacement occur?
Factors that provoke displacement can be: spinal injuries, heavy physical activity, unsuccessful and sudden turns of the body. In all these situations, the pressure on the intervertebral discs increases significantly. As a result, the spinal canal narrows and the nerve endings are compressed. Most often, displacement occurs in the lumbar spine.
In adolescents, vertebral displacement is possible due to weakness of the back muscles. This is due to the rapid growth of bone tissue and weakness of muscle development in the lumbar region, as well as a lack of general physical development. In old age, the disease is a consequence of age-related degenerative changes (osteochondrosis).
Common reasons:
- physical exercise
- congenital disorders of the spine
- static voltage
- spinal injuries
- complications of osteochondrosis
- curvature of the spine
- arthrosis
- muscle weakness
- malignant neoplasms
general information
Spondylolysis of the l5 vertebra is a defect of the arch of the bone segment. This is an abnormality characterized by gaps between joints in the spine. There is no connection between the segmental parts, which cannot be attributed to the physiological norm. The pathology is quite common and is detected in approximately 7% of the population. Patients include both young people and pensioners, regardless of gender and profession. Recent studies have confirmed the influence of genetic predisposition. Almost all patients had relatives with a similar problem.
In most cases, the lumbar region is affected when the 5th vertebra is affected. But in approximately 10% of patients, the pathology is determined in the 4th segment. Possible simultaneous lesions of L4 and L5. The risk group includes people actively involved in sports (American football, weightlifting, diving, rowing, gymnastics). The disease causes pain and often causes spondylolisthesis, a slippage of a vertebra.
Degrees of displacement
1st degree - displacement area less than 25%
2nd degree - displacement up to 50%
3rd degree - from 50 to 75%
4th degree - over 75%
5th degree - complete displacement without contact of surfaces and with prolapse of the vertebra
1. Pain appears in the lumbar region, usually worsening when bending over and sitting for long periods of time.
2. The nature of the pain intensifies with active movements and becomes permanent. There is a more pronounced displacement of the fifth vertebra.
3. The body shortens and sinks into the pelvis. Movement in the lumbar region is limited.
4. The chest and stomach are pulled forward, the gait changes.
Classification of the disease
Spondylolysis comes in different types; it is differentiated depending on the location. A defect in a vertebra occurs:
- Typical. Forms in the interarticular space and is observed in most patients.
- Atypical. Appears between the base of the vertebral arch and the joint gap. Diagnosed much less frequently.
- Retrosomatic. Changes are observed directly behind the body of the bone segment, at the root of the arch.
Spondylolysis can be observed only on one side, unilateral, or the defect is present on both sides, then it is called bilateral. The arch does not fuse on both the left and right, but there may be no symmetry; the parameters of the clefts often differ from each other. If the integrity of the arc is violated equally on both sides, then the defect is called symmetrical.
Stages and symptoms of spondylolisthesis:
1. In the initial period, the disease often occurs without symptoms and can only be detected on an x-ray. Pain syndrome occurs periodically - with a sudden change in body position or physical activity.
2. In the second stage, the pain is longer lasting and occurs immediately after physical activity.
3. During the third stage, the malaise is pronounced. There is noticeable stiffness when moving, severe pain, numbness, and possible disorders of the genitourinary system. The intervertebral discs become thinner, the spine begins to sag, and pinching of the nerve roots may occur.
4. At the fourth stage, the disease makes irreversible changes to the structure of the spine. Severe muscle weakness appears, gait changes, there is no possibility of independent movement over long distances, numbness appears in the lower extremities, severe chronic pain in the lower back, and convulsions occur. If left untreated, the disease progresses rapidly and a person may become disabled.
The exact diagnosis is determined by the doctor based on MRI or x-ray data taken in two projections and the patient’s complaints.
Spondylolisthesis responds well to complex conservative treatment at the initial stage. It necessarily includes exercises to strengthen muscles and create a muscular corset for the spine, as well as drug therapy to restore the elasticity of cartilage tissue.
Surgical complications.
- Bleeding from the veins of the epidural tissue during microsurgical discectomy and vertebral reduction is possible quite often. With the surgeon's leisurely actions using a coagulator with a low current intensity, eliminating the “burning” of the vessel walls, the likelihood of heavy bleeding decreases. Bleeding from the veins of the epidural tissue during vertebral reduction is treated with tamponade with hydrogen peroxide wipes.
- Damage to the roots is possible when the root is retracted during microdiscectomy and when pedicle screws are inserted incorrectly.
- Neurological disorders after reduction. The system of vertebral reduction carried out by various transpedicular screws is very powerful and the reduction should be carried out very carefully under visual control of the tension of the roots.
Complex conservative treatment:
prescribing painkillers, muscle relaxants and antispasmodics to relieve tension in the back muscles and relieve pain.
- local blockades of the spine in places of displacement of the vertebrae with injections of hormonal drugs.
- therapeutic massage (not prescribed during periods of acute pain)
- acupuncture
- use of chondroprotectors
- physiotherapy (electrophoresis, paraffin, salt or radon baths)
- physiotherapy
After eliminating the displacement of the vertebrae, the doctor may recommend wearing a specialized corset or belt to fix the spine. This will significantly reduce muscle tension and pain.
Causes
Spondylolysis defect develops for a variety of reasons. Scientists and doctors have not established the exact prerequisites for the formation of such an anomaly. In the case of intrauterine development, the causes may be bad habits of the mother or past infectious diseases.
The acquired form appears under the influence of the following factors:
- Previous injuries to the musculoskeletal system.
- Individual features of the anatomical structure of the ridge.
- Acute disturbance of blood flow in the bone area.
- Sprains or dislocations, other injuries in the lumbar region.
- Excessive physical activity.
Spondylolysis in the lower back is often detected in people who lead an active lifestyle and play sports. Uneven pressure on the bones can become a provoking factor for the appearance of anomalies. Therefore, traumatology divides the disease into several categories:
- Congenital. It develops in utero, during the period of active formation of the musculoskeletal system. The disorder is diagnosed after birth.
- Acquired. Appears under the influence of negative environmental factors. This can be physical activity, mechanical stress, poor nutrition, frequent fractures, and more.
- Mixed. Against the background of existing spinal arch dysplasia, a person experiences additional stress or injury, which leads to the development of an anomaly.
Regardless of the cause of the appearance, the patient needs timely diagnosis of the deviation and treatment. Only a comprehensive impact on the problem can eliminate complications.
An x-ray can detect a pathological condition
Physical therapy to help!
The selection of a set of necessary physical exercises for a patient with spondylolisthesis is carried out only by a specialist!
More often, static exercises and complexes aimed at stretching tendons and muscles are recommended.
It is forbidden:
- Perform exercises when pain worsens
- Exercise in a vertical position.
- Increase the tilt of the body by more than 20 degrees (in this case, repeated displacement is possible).
If conservative treatment methods do not lead to the expected result, the doctor may recommend surgery. To avoid surgery, if there is any suspicion of vertebral displacement, it is necessary to urgently be examined by a specialist!
General symptoms
Spondylolysis l5 progresses quite quickly and gives the following symptoms:
- The appearance of pain in the sacral region;
- Increased discomfort when standing still for a long time;
- Tension of muscle structures and the development of kyphosis due to load redistribution;
- Reduced height due to curvature of the spinal column and its reduction;
- The appearance of skin folds on the sides and the presence of difficulties when bending forward;
- Noticeable clubfoot and change in gait, which occurs due to improper load distribution.
Similar symptoms are typical not only for spondylolysis l5, but also for many diseases associated with pathologies of the musculoskeletal system. This makes making a diagnosis much more difficult.
Diagnostics
As soon as symptoms of possible antelesthesis of the fifth lumbar vertebra appear, it is better for the patient to immediately go to the hospital. By that time, during the initial examination, the patient’s spinal asymmetry will already be clearly visible.
Antelesthesis of the L5 vertebra is detected due to the characteristic displacement of the spinous process forward. If this vertebra is damaged, however, it will be more difficult to detect deformity and displacement. In this case, the spine is palpated throughout the entire lumbar region in order to preliminary confirm the diagnosis.
There is also a functional test. It is light, but will allow you to immediately confirm or refute the presence of antelesthesis of the fifth lumbar vertebra. To perform it, the doctor needs to place his fingers near the patient’s vertebrae. The patient must stand. Then the doctor asks him to reach his socks with his hands. In the process of bending the body of a sick patient, the doctor discovers a pathological change.
To determine antelisthesis of the lumbar vertebra, careful diagnosis is necessary
After the initial examination, the doctor directs you to undergo instrumental diagnostic examinations. Most often, lumbar radiography and computed tomography (CT) are prescribed.
During an X-ray of the lumbar region, two pictures are taken - lateral and direct, which allows you to determine the stage of development of the disease, how much the vertebra is displaced, and also to indicate the final diagnosis as accurately as possible.
Important! In the early stages, antelisthesis of the L5 vertebra is difficult to detect during diagnosis, since this vertebra is fused to the sacrum. In addition, at the beginning of the development of pathology, the displacement will be barely noticeable.
Results
Antelisthesis of the fifth lumbar vertebra is a dangerous disease caused by various reasons. Being in the first or second stages, the disease is practically asymptomatic - there is only slight pain and discomfort in the lower back. However, at the third and fourth degrees, the clinical picture completely changes and becomes extremely depressing.
To diagnose the disease, there is no need for expensive research - an initial examination, medical history and x-ray are sufficient. However, antelisthesis in the early stages is not so easy to diagnose.
It is quite possible to cure antelisthesis, the main thing is to detect it in time
If it is possible to detect the disease in time, then the conservative method of treating antelesthesis will be quick and effective. In addition, it will in no way affect the patient’s quality of life.
Advice! If you are always on the alert and undergo regular examinations, you will not have to resort to surgical intervention.
Neurological manifestations
With spondylolysis l5, compression of nerve endings and roots occurs. As a result of such changes in the body, neurological symptoms develop:
- Decreased sensitivity of the skin in the perineum, genitals and lower extremities;
- There is a tingling sensation and numbness in the legs;
- Characteristic muscle weakness appears.
If no therapeutic measures are taken in time, relative or complete urinary incontinence develops or problems with defecation occur. In severe cases, it is possible that men will develop impotence.
Return to sports[edit | edit code]
With conservative treatment, sports activities will be allowed to resume after clinical improvement: athletes can return to activities after the disappearance of pain, regardless of the presence of radiological signs of fusion of the interarticular part of the arch. At the same time, participation in high-risk sports - football (including American football) or gymnastics - reduces the likelihood of a favorable outcome by five times compared to low-risk sports - baseball, track and field or swimming.
The timing of return to sports after surgical treatment is controversial. We believe that if fusion is confirmed, there is no pain, range of motion is restored and the muscle corset is strengthened, the athlete can return to training. This may take from 5 to 12 months.