Why is spondylolysis of the l5 vertebra dangerous and how to treat it?

30.01.2021

Spondylolysis of the spine is a defect of the vertebral arch when the arch does not fuse in the area between the joints or in the pedicle due to delayed development of the posterior part of the spine. In 99% of cases, spondylolysis occurs in the lumbar region and in 85% of cases affects the 5th vertebra, in 10% of cases - the 4th vertebra. Simultaneous defeat also occurs.

This is a reversible disease that, if diagnosed at an early stage, can be treated without surgery. Spondylolysis of the spine can be asymptomatic, and, as a rule, its mild forms are accidentally discovered during a comprehensive examination.

Who is at risk

Spondylolysis l5 is a fairly common disease. If we take into account statistics, the disease is diagnosed in 5-7% of the world's population.

At a young age, the disease affects both girls and boys. In elderly people, pathology is diagnosed in men 2 times more often than in women.

Some experts believe that this pathological process can be inherited

Simultaneous damage to several segments of the spinal column is possible.

Athletes and people suffering from physical inactivity are equally susceptible to the development of spondylolysis. Basketball players, rowers and wrestlers have greater risks of disease progression.

What is spondylolysis

In order to answer what spondylolisthesis is, it is necessary to understand the details. The disease is a displacement of segments of the spinal column relative to one another. Spondylolisthesis is quite difficult to treat and is accompanied by characteristic pain.

Spondylolysis of the spine l5 is an anomaly characterized by gaps between the articular structures of the spine. There is no bony connection of the segmental arches in this case. From a medical point of view, the pathological process is called a vertebral arch defect or ossification. In 67.7% of cases of spondylolysis, damage to the l5 lumbar spine (fifth leg of the arch) is observed.

Causes of spondylolysis

There are three main causes of this defect in the spinal column:

• congenital - this option occurs when non-fusion of ossification nuclei occurs;
• acquired - occurs when increased physical activity and insufficient nutrition of bone tissue are combined;
• mixed - this option combines the two previous ones, when there is a congenital defect in the structure of the vertebral arches and under the influence of intense physical activity it intensifies and manifests itself with a number of symptoms.

Provoking factors

The root causes of damage to bone structures have not yet been established. The congenital form of the disease is formed in utero, during the period when the fusion of foci of ossification occurs, which make up one half of the arch of the segment.

The acquired form develops against the background of the following factors:

• Injury to the spinal column;
• Individual features of the anatomical structure of the spinal column;
• Disorders of nutrition and blood circulation in the area of ​​bone structures;
• Rotating injuries in the lumbar region;
• Repetitive strains of muscle tissue in the back.

As a result of the factors listed above, a fatigue fracture develops in the area of ​​the vertebral arch. Among the most dangerous sports are throwing, bobsleigh, boxing, rhythmic gymnastics and rowing.

Symptoms

Spondylolysis is a common disease that affects about 7% of the world's inhabitants. Before the age of 20, men and women get sick equally often; after 20 years, men get sick twice as often. There is a hereditary predisposition: children with spondylolysis are more likely to develop the disease.

Spondylolysis of the spine occurs with equal frequency in both physically active and inactive people, but some sports increase the likelihood of getting sick: rowing, American football, wrestling, weightlifting, gymnastics and diving.

Spondylolysis may occur without symptoms. Signs of the disease appear over time: stiffness and periodic prolonged moderate pain in the lower back. Pain often occurs if a person sits in an uncomfortable position for a long time, walks for a long time, or stands up suddenly. Sometimes these symptoms occur while lying on your back. Another symptom is a decrease in pain when bending forward and increased pain when extending. In rare cases, patients experience severe pain that limits mobility and pain in the buttocks and hamstrings.

Classification of spondylolysis

Spondylolysis l5 according to the mechanism of development is functional, dysplastic and overload. In the first case, we are talking about the development of a pathological process in young people who lift weights without observing preventive measures. The dysplastic form of the disease is formed due to pathologies of intrauterine development, if there are pathogens in the family. Overuse spondylolysis is characterized by progression during professional sports.

Depending on the duration of the disease, it can be acute or chronic. Acute spondylolysis l5 develops against the background of a single exposure to a damaging factor. This leads to disruption of the integrity of the vertebral arch. In the chronic form of the disease, we are talking about the formation of a defect over a long period of time.

The pathological process of L5 spondylolysis differs according to the location of the gap:

1. Typical – the formation of a gap occurs in the interarticular area;
2. Atypical - the formation of a lumen occurs between the joint base of the vertebral arch;
3. Retrosomatic - develops near the root of the arch.

The difference in the nature of the lesion should also be mentioned. We are talking about one-sided and two-sided forms. Violation of the integrity of the arc is also possible in symmetrical areas.

Unilateral

The pathological process is localized only in one part of the vertebral arch. Statistically, the right side is most often affected.

Classification

L5 spondylolisthesis can have several types:

• forward displacement – ​​anterolisthesis;
• backward displacement – ​​retrolisthesis;
• displacement to the left or right – laterolisthesis.

The classification may also relate to the degree of vertebral displacement. There are the following degrees:

1. 25% of the vertebra is displaced in relation to the underlying one - the first.
2. 50% – second.
3. 75% – third.
4. 75-100% – fourth.
5. Full displacement - fifth.

At the fifth stage, so-called spondyloptosis occurs. This condition can only be treated surgically and is very serious.

Stages of progression

The intensity of manifestations of spondylolysis l5 depends on the degree of progression of pathological changes:

• Stage 1 – there are no symptoms, so the patient is not aware of the abnormalities occurring in the body and does not begin treatment on time. Only in rare cases does minor pain appear in the lumbar region.
• Stage 2 - discomfort appears during physical activity. In rare cases, pain occurs when the patient is at rest.
• Stage 3 – pain is constantly present. There is a possibility of paralysis. Impaired mobility occurs in the lumbar region, which impairs lifestyle.
• Stage 4 – a change in gait and body shape occurs. Posture is disturbed - the curvature becomes noticeable to the naked eye. The pain becomes constant and has a debilitating effect on the person.

The sooner treatment measures are taken, the greater the chances of a full recovery. Only competently prescribed therapy guarantees that complications of the disease will not develop.

3. Diagnosis of spondylolisthesis

In the diagnosis of spondylolisthesis, establishing a connection between back pain and spondylolysis is of great importance. Diagnostics confirming spondylolisthesis should also exclude other possible causes of back pain (hernias, neoplasms, osteochondrosis, etc.).

The diagnosis of spondylolisthesis is established clinically (based on symptoms) and confirmed by X-ray examination, MRI or computed tomography.

The nature of the pain, its localization, frequency and connection with motor activity, and associated disorders (numbness of the legs, paresis, pelvic disorders) are important. In addition to detecting the actual displacement of the vertebra, studies are usually aimed at assessing the effect of this condition on nerve conduction and possible entrapment of the spinal cord and exiting nerves.

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Clinical manifestations

Lumbar spondylolysis of the spine is characterized by the absence of severe symptoms in the initial stages of progression.
That is why most patients seek help from a doctor quite late, when there are already serious risks of complications. As the disease progresses, symptoms increase. Signs of spondylolysis l5 can be divided into general and neurological.

In the first case, the disease is often mistaken for other pathological disorders, so diagnosis is complicated.

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.

4. Treatment of the disease

Conservative treatment

with spondylolysis and spondylolisthesis in many cases it gives a good positive effect. It usually consists of strengthening the abs and lower back muscles - creating a “muscle corset”. Additional measures can be aimed at relieving pain and relieving muscle spasms in the lumbar region. Sometimes wearing a corset is recommended, but it must be borne in mind that this is only justified in severe painful conditions, because Wearing a corset for a long time weakens the lower back muscles, which can only aggravate the disease after the external support of the spine is removed.

The ineffectiveness of conservative treatment methods, severe progressive pain, neurological symptoms, and a significant decrease in quality of life due to spondylolisthesis serve as the basis for more radical treatment methods. Surgical assistance

usually aimed at stabilizing the destroyed one and ensuring the immobility of neighboring vertebrae. In this case, as a rule, the excess connective tissue that has formed is removed, which narrows the lumen in the vertebrae, compresses the nerve roots and causes pain. The postoperative period in this case is quite long: first, two months of bed rest, then a plaster corset, strict restrictions on activity, observation by a vertebrologist, physiotherapy, specific gymnastics, sleeping on a hard bed in

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.

Our doctors for the treatment of spondylolysis of the L5 vertebra

The “Aspect of Health” clinic is headed by an experienced doctor (neurosurgeon and neurorehabilitation specialist with extensive experience) - Albert Rinatovich Khusainov. He has many satisfied patients and many years of experience in treating spinal diseases, including the most complex cases.

Our clinic employs specialists of various profiles - neurologists, vertebroneurologists, physiotherapists, osteopaths, chiropractors, reflexologists. All doctors have extensive experience in the treatment of various spinal pathologies.

Possible consequences

Spondylolysis is a serious disease that is not independent in nature, but occurs against the background of congenital or acquired abnormalities of the spinal column. The pathological process is characterized by stepwise progression. The final stage of the pathological process is the exit of the affected vertebra from the conditional line.

Disturbances occurring in the body lead to the development of the following complications:

• Curvature of the spinal column;
• Reduction of the lumen of the spinal canal;
• Pressure on the intervertebral disc of the affected segment;
• Deformation of nerve endings and compression of the spinal cord.

If treatment measures are not taken in a timely manner during spondylolysis, then serious complications develop, which lead to the development of severe conditions and cause the development of disability and loss of ability to work.

Establishing diagnosis

What is spinal spondylolysis is clear. How is this disease diagnosed? To begin with, the doctor assesses the patient’s medical history and lifestyle:

• The presence of a depression or protrusion l5;
• Definition of retraction syndrome, indicating movement of the segment;
• Tension of the muscle structures responsible for straightening the spine;
• Presence of Turner's symptom (formation of kyphosis and pathological lordosis);
• Formation of skin folds, protrusion of the chest and shortening of the lumbar region;
• Change in gait - the hip and knee joints are bent, the feet become slightly crossed.

Diagnostics

To make a diagnosis, the doctor examines, palpates the spine and checks for limited extension in the lumbar region. Asks the patient to stand on one leg and bend back - with spondylolysis, the pain at the site of the lesion intensifies. Then the doctor prescribes clarifying diagnostic methods:

• radiography (X-ray) of the spine in lateral, straight and two oblique (left and right) projections. A vertebral arch defect is detected in 85% of cases;
• computed tomography (CT) of the spine - more precisely, the defect of the arch is examined on horizontal sections;
• scintigraphy and single-photon emission tomography - the most accurate study of the location of the defect or fracture;
• magnetic resonance imaging (MRI).

Treatment

Spondylolysis l5 progresses quite quickly. In order to prevent the development of complications and stop the course of the pathological process, therapeutic measures should be taken in time. If primary symptoms appear, you should seek help from a neurologist. The specialist will prescribe:

1. Drug treatment;
2. Physiotherapeutic effects;
3. Surgical intervention.

In the initial stages of development of lumbar spondylolysis, outpatient monitoring can be done. In advanced cases, hospitalization cannot be avoided. The patient is admitted to the hospital for constant monitoring.

Drug therapy

Medicines are prescribed during an exacerbation to relieve pain. The doctor selects the medications based on the results of the diagnostics. Among the most effective means are:

• Non-steroidal anti-inflammatory drugs - Meloxicam, Diclofenac and Ketorol;
• Drugs that improve the nutrition of internal structures - Riboflavin, Pyridoxine and Thiamine.

Physiotherapy

With spondylolysis L5, physiotherapy cannot be avoided. Treatment of this type is prescribed to eliminate pain, improve nutrition of nerve structures and relieve muscle spasms.

The most effective physiotherapy for lumbar spondylolysis:

• Electrophoresis;
• Magnetotherapy;
• DMV therapy;
• Ultrasound;
• Laser therapy;
• Baths with hydrogen sulfide.

Physiotherapy

Exercise therapy is recommended only after pain relief. Gymnastic exercises, performed using a special technique, are aimed at restoring the tone of muscle structures and strengthening the muscles in the back.

For the first time after an illness, it is recommended to wear an orthopedic corset during classes and other physical activities. Thanks to special designs, it is possible to reduce the load on pathologically damaged segments of the spine.

Surgical intervention

The operation for lumbar spondylolysis l5 is performed by a neurosurgeon. Surgical treatment is used only if conservative therapy does not produce the desired result. The purpose of the operation is to fix the damaged vertebral arch using screws, pins and hooks.

Surgical intervention is aimed at immobilizing the spinal column in the lumbar region through implantation. The procedure is performed under general anesthesia.

Treatment methods

Treatment of lateral, posterior or anterior L5 spondylolisthesis occurs only in combination. Medicines, physical therapy, bandages and corsets, as well as physiotherapy and visits to a chiropractor are prescribed. However, in some advanced cases, surgery is prescribed. It is needed when, despite all the manipulations, the vertebral body continues to shift, the patient suffers from severe pain and serious neurological manifestations. The recovery period after surgery can be six months.