Today, almost all middle-aged and elderly people know from personal experience what vertebral displacement is. Each of them at least once experienced severe back pain, which was preceded by a click somewhere in the spine, heard at the moment, for example, of stretching, and then stiffness in the body.
That same sound signaled the displacement of the body of one vertebra relative to another forward or backward. If such displacements occur regularly, this may signal spondylolisthesis, a disease of the spine that can lead to deformation and other unpleasant and painful sensations.
- Classification of vertebral displacements
- Reasons for appearance
- Symptoms
- Consequences
- Diagnostic methods
- Our treatment methods
- Prevention
| ✓ Experience and qualifications of specialists |
| ✓ Individual approach and safe methods |
| ✓ Quality control during the treatment process |
| ✓ Successful results |
Disc herniation L4 L5: signs, possible complications and treatment methods
In more than half of the cases, intervertebral hernia affects the lumbar spine, especially its last segment, which is formed by the L4 and L5 vertebrae, as well as the intervertebral disc located between them.
In 46% of cases, lumbar hernia is localized precisely in the L4 L5 segment. A protrusion in this place can cause compression of the l5 spinal nerve. In this case, the innervation of the limbs is disrupted, sensitivity decreases, motor amplitude decreases, and muscles atrophy.
L4 L5 disc herniation is the most dangerous. It can disrupt the functioning of organs located in the pelvic area, limit motor activity, and cause partial or complete paralysis.
The disease manifests itself immediately after the formation of a protrusion: aching pain appears in the lumbar region and lower limb, lumbago, the leg goes numb, it is difficult to bend the knee, the foot partially loses its functions.
But don’t be upset: modern medicine can eliminate pathology without surgery and restore damaged areas of the disc by 80%.
Causes
As a rule, retrolisthesis is rarely detected in children, except perhaps in adolescents and those in high school. In younger children, this pathology is observed only if they professionally engage in difficult and traumatic sports. Also, this type of deformation is typical for people who have been in an accident, or children who have fallen from a swing. But in general, the disease is more often diagnosed in adults.
Falling is one of the most common causes
The main reasons for the development of the disease are as follows:
- injury to the vertebral discs or active degenerative processes in the segments of the spinal column;
- serious load on the spine;
- ligamentous rupture or damage to the back muscles;
- damage to the vertebral arches and destruction of their processes;
- hypertonicity of the back muscles, combined with ligament weakness;
- spinal column surgery;
- amyotrophy;
- the presence of hereditary pathologies;
- the presence of tumors or active inflammatory processes;
- vertebral compression fractures caused by osteoporosis or age-related changes.
Retrolisthesis occurs mainly due to various types of injuries
The most susceptible to retrolisthesis are athletes (weight lifters, gymnasts, acrobats), circus performers, builders and those who often drag heavy objects while performing work duties. The disease extremely rarely manifests itself without concomitant pathological changes in the structures of the spinal column.
The L5 vertebra is the most mobile among all segments of the lumbar region. And that is why he most often “stands out” from the general series.
Location of lumbar vertebra L5
Medial hernia (also called Schmorl's hernia)
Shows no signs.
There are also symptoms common to all types:
- increased pain during physical activity, eating, defecation;
- relief of pain in a standing position;
- autonomic disorders (sweating increases, legs swell, skin becomes dry);
- unbearable pain if you try to lift your straight leg while lying on your back, and the disappearance of pain if you bend the raised leg at the knee.
Treatment methods
The choice of therapeutic methods depends on the type and size of the hernia. Therefore, the doctor refers the patient to a computer or magnetic resonance imaging scan.
Hernias with a diameter of less than 5 millimeters do not require hospitalization. They are treated with physical therapy and traction – spinal traction.
For a hernia whose diameter is within 5-8 millimeters, drug treatment, physiotherapeutic procedures, therapeutic exercises and massage are prescribed.
If the diameter of the hernia is in the range of 8-12 millimeters, then in case of exacerbation of the disease, hospital treatment and bed rest will be required. When the pain completely disappears, the patient is transferred to outpatient treatment. The operation is prescribed only if there is severe compression of the spinal cord or signs of a “cauda equina” appear (this is the name given to the symptoms accompanying the advanced form of the disease: impaired motor function of the lower extremities, problems with urination).
If the diameter of the hernia exceeds 12 millimeters, then urgent surgical intervention is necessary.
Peculiarities
The L5–S1 intervertebral disc is located between the last lumbar vertebra and the sacrum. This is the largest disc in the spine, the diameter of which significantly exceeds the height. But due to the high load placed on him, he more often than others suffers from the development of osteochondrosis, then protrusion and, ultimately, a hernia.
But if previously such changes were mainly observed in older people, today intervertebral hernias have become much younger and are increasingly occurring even in young people. The main reason for their formation is advanced osteochondrosis. Create the prerequisites for its development:
- sedentary lifestyle, sedentary work;
- overweight;
- regular performance of heavy physical labor;
- back injuries;
- spinal deformities in any plane;
- genetic predisposition.
Thus, under the influence of these factors, degenerative-dystrophic changes begin in the tissues of the L5–S1 intervertebral disc. Initially they affect the inner part of the disc - the nucleus pulposus. Tears gradually form in its fibers, which leads to an uneven distribution of pressure on the surrounding fibrous membrane. Under the influence of the shifting nucleus pulposus and pressure from the vertebrae, it experiences serious overloads, as a result of which the fibers of the fibrous ring also begin to gradually stretch and tear in the place where their strength is minimal as a result of injury or other factors.
Thus, the symmetry of the intervertebral disc is disrupted. At a certain point there is a slight protrusion of the nucleus pulposus and the entire disc beyond the vertebral body. But since the nucleus pulposus still remains within the annulus fibrosus, in such situations L5–S1 disc protrusion is diagnosed.
The shock-absorbing properties of the disc begin to decline immediately after the first changes occur in it. Even a slight protrusion can lead to disturbances in the patient’s well-being and pain syndrome.
If no action is taken at this stage, the deformity will worsen, since the pressure of the vertebrae on the disc does not disappear, and the fibers of the fibrous membrane continue to be subject to constant pressure. As a result, it cannot withstand and ruptures, against which prolapse and herniation of the L5-S1 disc are diagnosed.
Thus, a passage is formed in the fibrous ring, through which the nucleus pulposus is able to get out, that is, into the spinal canal. This is what leads to the development of acute neurological symptoms characteristic of a hernia, since a mass of nerve endings from the cauda equina pass through the spinal canal. Therefore, the appearance of even a small foreign body in it leads to their infringement and the occurrence of corresponding disturbances in the functioning of those organs for the innervation of which they are responsible.
Therefore, with a hernia of the L5–S1 spine, severe pain is observed not only in the lower back, but also in the legs, feet, toes, sacrum, buttocks, etc. There is also a violation of their sensitivity, extinction of reflexes and other changes. Moreover, the nature of the clinical picture largely depends on the type of hernia.
Conservative treatment
First of all, you need to ease the load on the damaged area. For this purpose, the patient is prescribed bed rest and a corset is recommended. At first, the corset is worn constantly, and later - only when there is load on the lower back.
Then the doctor selects drug therapy, including:
- analgesics;
- non-steroidal anti-inflammatory drugs;
- glucocorticosteroids;
- muscle relaxants;
- chondroprotectors;
- vitamin complexes.
When the pain syndrome stops, drug treatment is supplemented with physiotherapy (UVR, electrophoresis, electrical stimulation), swimming, and therapeutic exercises.
Physiotherapy
In the treatment of L4 L5 disc herniation, physical therapy plays a leading role. It relieves muscle tension and strengthens the back muscles.
The peculiarity of a herniated disc L4 L5 is that it causes muscle imbalance: some muscles relax, while others tense. Therefore, an experienced physiotherapist should select exercises and monitor their implementation. Self-study, instead of improving the condition, will lead to an exacerbation of the problem and pinched nerves.
For L4 L5 disc herniation, it is recommended to exercise in a lying position. Exercises that place a strong load on the lower back (bends, lunges, swings, squats) should be excluded from the complex.
Strengthen the back muscles and help return the intervertebral disc to its previous position.
Develops the muscles of the lower back, making them elastic. As a result, the flexibility of the spine increases and the general condition improves.
Advantages of surgical treatment:
- The speed of onset of the analgesic effect The patient the next day feels a significant reduction in pain in the leg, only minor pain in the postoperative wound remains. With conservative therapy, achieving this effect requires time from 1-2 months to 1 year.
- Radicality of treatment Removal of an intervertebral hernia relieves the patient of pain for many years, unlike patients treated conservatively. The latter have to relieve attacks of exacerbation of back and leg pain several times a year, which become stronger and longer lasting every year.
Surgical treatment
The main goal of surgery is to relieve nerve structures from pressure.
In modern medicine, 4 types of operations are used to treat hernia:
- microdiscectomy (the method is considered the most effective) - a hernia is cut out, minimally injuring the body;
- endoscopic treatment - the hernia is removed through small punctures (no incisions are made), all manipulations are controlled using a computer;
- implantation – the damaged disc is completely cut out and replaced with an artificial implant;
- nucleoplasty - a puncture is made in the skin, through which electrodes are inserted that deliver electrical impulses; under their action, the core of the disc is evaporated, freeing the nerve root.
Thanks to the operation, it is possible to quickly relieve pain and restore the conductive ability of the nerves. But it is unable to eliminate the cause of the pathology. Therefore, relapses are often observed after surgery.
Alternative techniques
Only comprehensive treatment can ensure complete recovery, which, in addition to traditional methods, also includes alternative ones:
- hirudotherapy – leeches are placed on the area where the hernia is located;
- ozone therapy – ozone preparations are injected into damaged areas using injections;
- homeosinia – homeopathic medicines are injected into reflex points.
The combination of innovative techniques with time-tested methods allows in 90% of cases to cure a herniated disc without surgery. And if you follow simple preventive measures, the disease will no longer remind you of itself.
Types and stages of retrolisthesis
There are 4 degrees of retrolisthesis depending on the level of vertebral displacement.
Table. Degrees of retrolisthesis.
| Degree | Characteristic |
| I | The affected segment shifts by ¼ relative to the vertebra located below. |
| II | The vertebra at this stage appears to be shifted by approximately ½. |
| III | In this case, a stronger slippage of the vertebra is observed - ¾ relative to the one located below. |
| IV | At this stage of retrolisthesis, the spine is shifted by more than ¾. |
Lost disc in the spine
The following forms of retrolisthesis are also distinguished:
- post-surgical , which appears after spinal surgery;
- dysplastic or congenital , characterized by the fact that the fifth lumbar vertebra initially developed incorrectly, which is why it shifted;
- traumatic , arising from injury;
- degenerative , which forms against the background of osteochondrosis;
- spondylolysis spondylolisthesis , which developed due to a fracture of the processes of the vertebral segment and disruption of the structure of the vertebral arch;
- pathological , formed due to a tumor or inflammatory process.
There are several forms of the disease
If you want to learn in more detail how to treat sacralization of the l5 vertebra, and also consider symptoms, diagnosis and alternative treatment methods, you can read an article about this on our portal.
Retrolisthesis can also be stable or unstable. The second form is the most dangerous, as it threatens to compress the spinal cord roots and cause severe compression. Such detailed classifications make it possible to make an informative and complete diagnosis, and any doctor can understand the condition of the spine just by looking at the patient’s card and reading the names.