Spondylolisthesis is a condition where one of the vertebrae slips forward or backward relative to the other vertebra. This happens due to the rupture of the pars articularis (the part of the vertebra that is responsible for articulation with another vertebra). Moving a vertebra forward is called anterolisthesis, while moving a vertebra backwards is called retrolisthesis. Usually, when spondylolisthesis is mentioned, it means anterolisthesis, which is much more common than retrolisthesis.
Spondylolisthesis can lead to spinal deformity as well as narrowing of the central canal of the spinal column. It most often occurs in the fourth and fifth lumbar and first sacral vertebrae (lower part of the spine), and somewhat less often in the neck. Spondylolisthesis can be congenital, traumatic, and degenerative.
Degenerative spondylolisthesis is a disease of the elderly population, which usually occurs as a result of arthritis. Traumatic spondylolisthesis is rare and occurs as a result of acute fractures, while congenital spondylolisthesis is present from childhood and occurs more often in women. There are five levels of spondylolisthesis where the fifth is total vertebral bypass.
Causes
The most common causes are degenerative changes, fractures, osteoporosis, tumors, traumatic injuries, disc herniations, various injuries of the lumbar spine, congenital spondylolisthesis. In congenital spondylolisthesis, the pars articularis does not fuse with the vertebra. In many research papers, the most common reason for the formation of spondylolisthesis is premature forcing of the child to sit and stand, as well as the use of a hole.
symptoms
Spondylolisthesis can be asymptomatic (so that the patient does not feel any discomfort), although this type of spondylolisthesis can also be recognized by an adequate physical examination, and symptomatic, which is most often presented by severe, sometimes dull pain in the back that increases when walking and decreases when lying down .
Weakness in the legs, urination disorder may occur. The pain can be similar to sciatica, spreading in the gluteal area, occurring in the thigh area, even in the calves. Pains that occur during walking often cause limping. Both legs may be affected. Neurological outbursts, reflex disorders may occur. Also, tightening in the area of the back lodge is characteristic.
Patients with spondylolisthesis tend to lean forward due to compensatory changes. Muscle atrophy occurs very often in the gluteal region. In addition to pain, burning, tingling and numbness may occur. Sneezing and coughing can make the pain worse. The pain can also increase when sitting, especially when the patient gets up after sitting for a long time. The range of motion in the lumbar spine can be reduced, or it can be normal.
Diagnosis
Most patients with spondylolisthesis have a pronounced lumbar curve and protruding buttocks. Sometimes the patient does not complain of symptoms that point to spondylolisthesis, so it is of great importance to perform a detailed physical examination. This is extremely important when it comes to people who practice, or plan to practice, sports.
Spondylolisthesis is easily diagnosed on the basis of the X-ray image, which shows the sliding of the vertebrae on the side view, while on the oblique images and the AP image, the rupture of the pars articularis is seen. The severity of spondylolisthesis is assessed based on the percentage of vertebral slippage.
Depending on the case, if necessary, CT and magnetic resonance findings are also performed.
Therapy
In chiropractic, several methods are used to treat spondylolisthesis. Using special machines, movements are passively introduced in the lower back, pushing the damaged vertebra back. Additional rehabilitation methods stretch/relax the muscles that pull the spine into an unwanted position, strengthen the muscles responsible for spine stabilization, and the therapists concentrate on regulating intra-abdominal pressure. In more severe cases, there is an optional surgical intervention.
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