Spondylolisthesis of the cervical and lumbosacral regions, prices for surgery

September 24, 2019

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3.4 out of 5

The term spondylolisthesis means slippage of a vertebra. As a result, one of the vertebrae is displaced relative to the underlying one, which can lead to neurological disorders and a number of other complications. In most cases, the cervical and lumbar spine is affected, spondylolisthesis of L5–S1, L4–L5, C3–C4 is especially common.

The pathology occurs in people of all ages, including children. In the latter case, it carries a particular danger, since changes in the anatomy of the spine of a rapidly growing organism very quickly leads to serious disruptions in the functioning of all organs and systems. Therefore, it is important to diagnose spondylolisthesis of the cervical or lumbar spine as early as possible and carry out proper treatment of the joints.

You can undergo a full diagnostics using the latest equipment and accurately determine the causes of back and neck pain at SL Clinic. With our help, you can find out in a timely manner what is causing discomfort and get advice from specialists in the field of vertebrology and spinal surgery. Our doctors are able to notice the slightest deviations from the norm in the spine and select the optimal treatment tactics, which will eliminate any unwanted symptoms in the shortest possible time and avoid the development of dangerous complications.

Types of spondylolisthesis

The main reason that spondylolisthesis occurs in the lumbosacral spine or other area is the destruction or initially insufficient fusion of the vertebral arch connecting the joints. Injuries, arthrosis, osteochondrosis and other similar diseases provoke an increase in the defect, as a result the vertebra becomes mobile and slides off the surface of the intervertebral disc.

When the vertebra moves backward, posterior spondylolisthesis is diagnosed, and when it moves forward, anterior spondylolisthesis is diagnosed. Sometimes combined deformities occur, in which the vertebrae are displaced in different directions. In some cases, especially against the background of arthrosis or osteochondrosis, staircase spondylolisthesis of the cervical spine is observed, for which simultaneous displacement of several vertebrae in one direction is typical.

To select the correct treatment tactics, it is important to differentiate false spondylolisthesis of L4–L5 and other segments, since this type of disorder is not characterized by pathological changes in the interarticular arch. With pseudospondylolisthesis, segments are displaced due to the presence of anatomical features of the spine during sudden movements. But diagnosing this form of the disease does not mean that it cannot lead to pinched nerves and other disorders. Like true L3–L4 spondylolisthesis, it requires treatment, but it will be of a slightly different nature.

Possible consequences

If a vertebra is displaced, serious complications can develop. This is explained by the fact that compression of the bone elements of nearby anatomical formations occurs.

Spondylolisthesis leads to the following disorders:

Thyroid disease.
Malfunction of the nervous system.
Hypertension.
Hearing and vision decrease.
There are difficulties with breathing.
Incontinence of natural secretions.
The spine is bent.
Sometimes impotence develops.

Complications often require surgery. Unfortunately, some consequences are not eliminated at all. Therefore, timely diagnosis followed by adequate treatment is necessary.

Symptoms of the disease

Initially, the pathology is asymptomatic, but as it progresses, patients begin to suffer from pain of varying intensity in the neck, lower back, coccyx or sacrum. Also typical are impaired mobility and neurological disorders, manifested by decreased sensitivity of the limbs, headaches, deterioration of hearing, vision, and functioning of the pelvic organs. Sometimes a violation of posture is noticeable due to a decrease in the length of the affected segment.

At the initial stages of development, treatment of spinal spondylolisthesis is carried out using conservative therapy, but since it practically does not manifest itself in any way, it is difficult to diagnose the disease during this period. In severe cases, it can only be dealt with surgically.

Vertebrologists at SL Clinic will help you get rid of the discomfort that accompanies degenerative spondylolisthesis. Our specialists are capable of performing operations of any degree of complexity, and the availability of the best modern equipment, combined with the high level of skill of doctors, reduces the risks of surgical intervention to a minimum. The spinal surgeon will thoroughly explain what vertebral spondylolisthesis is, give an objective assessment of the situation, select the most effective treatment method, and further guide the patient until complete recovery.

Some tips ↑

You should start doing a set of exercises with just one exercise.

If it does not cause pain, then after about 3-4 days you can try the following.

So, gradually, adding one exercise at a time, perform the entire complex every day.

You should only perform exercises that do not cause pain. If it does occur, then they are not suitable for you and you should choose others.

In order to avoid exacerbation of the disease, it is necessary to observe the correct motor mode, from which carrying heavy objects or at least their even distribution is excluded. You also need to watch your posture.

If cyclic training is necessary, then you should give preference to simple cycling, exercise bike and swimming.

Unlike other sports, they do not cause impact on the vertebrae.

Do not engage in physical therapy or yoga during an exacerbation of the disease.

Physical therapy for spondylolisthesis is not a panacea that will help completely cope with the problem, but it is still the main method of maintaining the spine in normal condition.

To do this, it is necessary to perform a set of exercises for a long time and not let the disease take its course.

Degrees of spondylolisthesis and indications for surgery

There are 5 degrees of vertebral displacement:

1st degree – the displacement does not exceed ¼ of the vertebral area, discomfort occurs only during physical exertion or sudden movements;
2nd degree - the vertebra is displaced by half, which is associated with the constant presence of pain and some decrease in mobility in the affected area;
3rd degree – the displacement is within 75%, which is manifested by increased pain and often the addition of neurological disorders;
4th degree – the displacement exceeds ¾ of the surface area of the vertebra, this forces the patient to significantly limit his movements and experience severe pain even in a calm state;
Grade 5 – the vertebra falls out completely.

Surgical treatment of spondylolisthesis is necessarily prescribed for grades 2,3,4 and 5, if the vertebrae remain in an incorrect position, regardless of the patient’s posture. For unstable spondylolisthesis, in which displacement occurs as a result of changes in body position, surgical intervention is recommended already at grade 1.

It is also always indicated for children under 14 years of age, even if grade 1 spondylolisthesis of the lumbosacral spine is diagnosed. This is due to the fact that the disease tends to progress quickly and cause serious damage to the child’s health.

In other cases, surgery can also be performed if conservative therapy carried out for six months does not bring results and a deterioration in the patient’s condition is observed:

increase in pain;
increased neurological symptoms, in particular the occurrence of radicular syndrome, the development of stenosis;
increasing the degree of vertebral displacement.

What is exercise therapy? The essence of the method

Therapeutic physical culture is a set of methods of treatment, medical rehabilitation and prevention based on the use of specially selected and methodically developed physical exercises. When prescribing exercise therapy, the nature of the disease, its characteristics, stage and degree of the pathological process in systems and organs are taken into account.

The therapeutic effect of physical exercise is based on strictly defined loads in relation to sick patients . There are general training aimed at healing and strengthening the body, and special training designed to eliminate disorders in certain systems and organs.

Please note that exercise therapy can be general purpose and for eliminating a specific disease

Exercise therapy for spondylosis allows you to increase joint mobility , stretch muscles, improve metabolic processes in the affected areas, and increase the level of compensation. Therapeutic exercise prevents further progression of the disease, accelerates recovery time, and increases the effectiveness of complex treatment.

Indications for use

Exercise therapy is prescribed in the absence, distortion and weakening of a certain body function due to a certain disease or its complication . In other words, physical therapy is indicated in cases where it is necessary to stimulate physiological processes and prevent the development of stagnation in the body.

Types of operations for spondylolisthesis

The main tasks of the surgeon are to restore the normal position of the vertebrae along with the nerve endings and their reliable fixation. This can only be achieved surgically. The choice of a specific technique is carried out mainly on the basis of the results of MRI diagnostics.

Orthopedic surgery

Surgical treatment of spondylolisthesis with this method involves fastening the vertebrae restored to their normal position with a special plate and fixing them with special screws. This ensures high-quality fusion of the vertebral bodies affected by spondylolisthesis and prevents recurrence of the disease in this segment.

The orthopedic technique provides a high percentage of complete recovery if all recommendations received from the doctor are followed during the rehabilitation period. But it can only be carried out if there are no neuralgic disorders.

Neurosurgical operation

Spondylolisthesis of the vertebra is often combined with pinched nerves of the spine, which provokes severe pain. In such situations, patients need the help of a qualified spinal surgeon who can carefully remove the pressure of anatomical structures on the nerve endings and the correct position of the vertebrae.

Spinal surgeons at SL Clinic will be able to accurately determine the cause of the pain syndrome and, with pinpoint precision, eliminate it in the most effective way. With our help, you will quickly get rid of all the symptoms accompanying spondylosis and spondylolisthesis and be able to return to a full life without pain.

The main causes of nerve compression are herniated discs, narrowing of the root canal and central spinal stenosis. After an accurate diagnosis, patients are recommended to undergo one or another operation:

Discectomy and spinal stabilization. Open surgery is traditionally used to repair herniated discs. It involves resection of the part of the disc that compresses the nerve roots. This leads to disruption of the stability of the spinal column, which requires the installation of a graft taken from the ilium or an implant made of synthetic materials. The vertebrae adjacent to the resected disc are connected with special rods or screws.
Foraminotomy. The procedure can be performed on all parts of the spine and is characterized by low invasiveness and a high level of safety. It is indicated for reducing the area of the natural openings of the spine through which nerve endings pass, which often accompanies lumbar and cervical spondylolisthesis. During the operation, the surgeon artificially expands the root canals, due to which the effect of decompression of the nerves is observed and pain is eliminated.
Laminectomy followed by stabilization of damaged segments. This type of surgical intervention is necessary for stenosis, accompanied by a narrowing of the spinal canal in which the spinal cord passes. When it is pinched, sharp, severe pain occurs. They can only be eliminated by resection of the vertebral arches in the affected area and removal of some of the excess scar tissue that puts pressure on the nerves. After laminectomy, it is necessary to stabilize the spinal segments, for which one or another system is selected.

If there is a choice, most often, preference is given to a stabilizing technique using interbody corporedesis with implants.

Spine surgeons at SL Clinic are fluent in the most modern methods of surgical treatment of spinal diseases. The exact type of intervention is always determined individually and depends on the degree of spondylolisthesis of the lumbosacral spine.

Spinal fusion of the lumbar spine

In the vast majority of cases, operations on the lumbar spine are performed via a posterior approach with the choice of an interbody method of fixation of the vertebrae. Intervention through the anterior approach is carried out exclusively in complex clinical cases and in case of comminuted fractures.

There are several ways to perform lumbar interbody fusion:

anterior (ALIF);
rear(PLIF);
transforaminal(TLIF).

To ensure that the immobilization of the spinal motion segment is as reliable as possible, the operation is often supplemented with transpedicular fixation. In this case, special metal structures are installed, which further strengthen the fastening of the vertebral bodies.

Anterior interbody fusion

The ALIF technique allows for extremely convenient access to intervertebral discs and vertebral bodies. Thanks to this, the neurosurgeon is able to freely remove the disc, eliminate pathological compression of the nerve roots and spinal canal, and install a cage. If necessary, the surgeon installs additional fixing structures.

When using the ALIF technique, it is possible to bypass the nerve bundles, which eliminates the possibility of their damage and the development of related complications. But it presupposes the need to move blood vessels, which can provoke bleeding.

Posterior interbody fusion

The PLIF method involves removing processes from both sides of the vertebra. This is followed by a radical discectomy. Cages are placed on both sides of the vertebra.

Sometimes they are replaced with expanding implants. Since they are smaller, the neurosurgeon only needs to perform a medial bilateral facetectomy (removal of the facet joints) and remove only the nucleus pulposus of the disc. These implants are equipped with screws. They are unscrewed with a special key, thanks to which the cages are firmly fixed in a given position.

A huge advantage of the technique is the ability to perform circular spinal fusion during one operation. But its implementation carries the risk of damaging the nerves, since the surgeon must push them back to gain access to the interbody space. The main danger of this is the development of paresis, paralysis and disruption of the intestines and urinary organs, which can lead to urinary and fecal incontinence.

Transforaminal spinal fusion

The TLIF technique is recognized as the least traumatic. It involves removing the intervertebral disc and performing spinal fusion on the side of the most severe stenosis.

Transforaminal spinal fusion allows you to preserve the integrity of the posterior supporting structures of the spine and fulfill the entire planned volume even in the presence of significant scar changes.

Features of preparation

Initially, an MRI is performed, the results of which determine the degree of displacement, the percentage of deformation and narrowing of the intervertebral discs. It is also necessary to perform an X-ray of the cervical or lumbar region in two standard projections with functional tests in the lateral projection. Based on this, it is chosen which spine surgery will be performed for spondylolisthesis.

As part of the preoperative examination, the following is prescribed:

UAC and OAM;
Doppler ultrasound of the vessels of the lower extremities;
CT;
electromyography.

Rehabilitation

The severity of the result of the surgical intervention largely depends on the correctness of the recovery period. The entire set of measures prescribed by specialists is aimed at eliminating the likelihood of relapse and the development of complications of the disease.

Surgical treatment of spondylolisthesis of the lumbosacral spine does not require prolonged bed rest in the postoperative period. You can get up for the first time only with the permission of the surgeon the next day. Any sudden movements or bends are unacceptable. You should refrain from lifting heavy objects and strenuous physical activity for at least 6 months.

Throughout the recovery period, pain of varying degrees of intensity may occur, as the installed screws and rods put pressure on the vertebrae. To eliminate them, painkillers from the NSAID group are prescribed.

In order to speed up recovery, patients are prescribed a course of physiotherapeutic procedures:

laser therapy;
electrophoresis;
sinusoidal modulated currents;
diadynamic therapy.

For each patient, the nature and duration of procedures is selected individually. Physical therapy is also mandatory. You should start regular exercise 2–4 months after surgery. Classes are recommended to be carried out under the supervision of experienced rehabilitation therapists who will be able to select the optimal load and list of exercises. Initially, they are performed from a lying position on the stomach or back. Gradually increase the duration of classes and the number of repetitions, complicate the exercises and add new ones.

Patients are recommended to wear a semi-rigid corset for 1 month. It will reduce the load on your back muscles and make movement easier. However, you should not use the corset for more than the recommended time, as this may weaken muscle tone too much and lead to re-occurrence of spinal problems. Regular swimming exercises have a beneficial effect on the condition of patients. Therefore, after completing the main stage of rehabilitation, with the permission of the attending physician, it is recommended to visit the pool at least twice a week.

Prospects for recovery

Spinal fusion is a major operation performed under anesthesia. On the first day after surgery, the patient remains in the intensive care ward under the supervision of medical staff. If there are no complications, he is allowed to get out of bed on the second day.

The recovery period after different types of spinal fusion lasts from 2 to 4 months. During this time, a person must avoid physical activity, wear orthopedic corsets and follow all doctor’s instructions. If the operation and rehabilitation period went smoothly, the patient soon returns to his usual lifestyle.

Note that after some operations, patients experience vertebral nonunion. This usually happens when doctors fix the spinous and transverse processes together. In this case, patients continue to experience back pain. If left untreated, non-fusion of the vertebrae can lead to serious consequences.

After mono- and bisegmental spinal fusion, a person practically does not notice restrictions in the mobility of the spine. But after fixing several PMS at the same time, he may experience difficulties in flexing and straightening his back.

Treatment of spondylolisthesis at SL Clinic

Modern medicine can offer many treatment options for various spinal diseases. Unfortunately, they are often diagnosed in late stages, when the only option to help the patient is surgery. But if previously, for its high-quality implementation, Russians were forced to go to Israel, Germany and other countries and significantly overpay for medical services, today the latest achievements in the field of spinal surgery are successfully implemented in practice in Moscow at the SL Clinic.

Contraindications

Spinal fusion cannot be performed if:

severe diseases of the cardiovascular system;
recent stroke or heart attack;
acute infectious diseases;
exacerbation of chronic diseases;
formation of fistulas of unknown origin;
blood clotting disorders;
varicose veins.

Traditionally, surgical treatment is indicated only for patients aged 12 to 60 years. In other cases, the possibility of surgical intervention is considered by a group of specialists.