Kinds, degrees, symptoms, treatment of spondylolisthesis of the spine
Spondylolisthesis is a disease of the spine, characterized by the displacement of the vertebrae relative to each other. The cause of the disease in most cases is the trauma that leads to disruption of the anatomical joint in the intervertebral segments.
About 5% of all cases of detection of congenital disease are. They appear due to genetic malformations of the vertebrae: cleft arches, defects of the vertebral body, the weakness of the cartilage of the vertebral segments in General.
Cause of disease
True spondylolisthesis is classified depending on the causes:
- Dysplastic spondylolisthesis
Degenerative spondylolisthesis is formed after 65 years of age and is particularly prevalent in women. A typical localization bias is the level of L4-L5 (lumbar segment between 4 and 5 vertebra). Some rarely observed listes L3-L4. The location of the pathology is due to the fact that these sections of the spinal column bear the maximum load when a man of physical work in a standing position.
Peresetsky type is characterized by the location of the defect in the interarticular bow. It is classified into:
- Lytic – occurs due to a hereditary defect of the bow;
- Broken – interarticular portion of the movable disc, so the vertebrae move upon the slightest physical impact;
- Traumatic – is a consequence of the injury.
Pathological spondylolisthesis occurs because of the presence of pathological changes in the posterior supporting structures of the intervertebral segment (with the defeat tumor or inflammatory diseases).
To understand what a spondylolisthesis, you should study the anatomy of the spinal segment.
What is the spinal segment
The Segment of the spine is the articulation between two adjacent vertebrae. Rear of complex is fixed by the facet joints, and serves as a shock absorber intervertebral disc. Shebalino-extensor movements are controlled by muscular-ligamentous apparatus. Facet joints limit the deflection of the vertebral segment and posterior limit of circular motion.
Degenerative changes in the spine (lack of nutrients and blood supply) leads to the fact that the functionality of the spinal segment is insufficient. His joints are subject to degeneration, so possible displacement of the vertebrae. Precipitating factor is trauma or secondary diseases (osteochondrosis, scoliosis).
Predisposing factors of spondylolisthesis:
- Incorrect position of the sacrum
- Frequent injuries of bone and musculo-ligamentous system of the spine.
No hard work after 65 years!
there is true and false spondylolisthesis
True spondylolisthesis occurs because of a violation of the anatomical relationships in the segmental articulation of the spine. The reasons described above. False displacement of the vertebrae occurs due to pathology of the muscular-ligamentous apparatus in the normal structure of the vertebral joints.
due to anatomical and physiological characteristics of the most vulnerable to displacement lumbar vertebrae. The cervical portion of the spinal column flexible satisfied, so listen it occurs infrequently.
false to Treat forms of the disease have methods of operation. The only way to restore the vertebrae at the usual place. Treatment true type of pathology requires the exclusion of the basic causes of the disease.
Symptoms of displacement of the vertebrae 1 and 2 degrees
depending on the degree of displacement of the vertebrae identify the following the extent of the disease:
- 1 degree – shift of ¼ the width of the body of the overlying vertebra in relation to the underlying;
- 2 degree offset at½;
- 3 degree – shift by 3/4.;
- 4 degree offset the full width of the body.
The symptoms of the disease are classified according to the flow:
- Sharp develops after dislocation of vertebra fracture or dislocation;
- Prolonged shape is formed in a lengthy degenerative process in the ligaments, discs and other anatomical structures of the vertebral column.
The Symptoms of spondylolisthesis 1 and 2 degrees are formed depending on the direction of displacement of the vertebrae:
- Side (false spondylolisthesis).
The Front displacement is accompanied by enlargement of the facet joints. There is still a possibility of compression of the vertebra the spinal cord. As a consequence, appear spinal pathology:
- Pain in lower back radiating to the lowerlimbs
- Paresis and paralysis of leg (complete or partial immobility);
- Involuntary urination and defecation.
At offset 1 degree, the patient complains of leg pain with the occurrence of neuralgia of the sciatic nerve. While walking or standing the pain intensity decreases. This is because when the disease is expanding the gap of the facet joints and compressed nerves.
Stretching of nerve fibers in this situation can cause constant pain in the lower back with limitation of mobility of the spine due to spasm of skeletal muscles (lumbago).
Degenerative spondylolisthesis most often starts with pain in the back and leg. Gradually it leads to immobility of the entire spine.
Unstable form of pathology – not to become disabled
Unstable spondylolisthesis 1 degree is most likely to occur after a spinal injury. Most often when it "falls" L3, L4 and L5.
Interestingly, the fourth lumbar vertebra is often shifted to women. In men, this phenomenon is rarely observed.
Instability in the affected segment leads to severe pain at any movement. With timely treatment can prevent disease progression to 2 and 3 degrees in which there is disability due to compression of the spinal cord and sciatic nerve.
However, without the operation, it is difficult to ensure complete restoration of the spine mobility in the affected segment, although in most cases in this situation is applied corneotherapy. This is due to the fact that any surgery on the spine involves the risk of damage to important anatomical structures (muscles, ligaments, nerves) that followed will forever limit the mobility of the operated parts of the vertebral column.
In unstable form, starting with 2 degrees, operative treatment with fixation of the damaged segment (see below).
Spondylolysis spondylolisthesis, which develops as a result of cleft of the vertebral arch, in most cases also require surgical intervention for closure of the defect with an artificial graft. This will prevent disability in the future.
Treatment without surgery
when Conservative methods are used 1 and partially with 2 degree of pathology, if the segment is stably fixed.
what is the purpose of conservative treatment is the displacement of the vertebrae:
- Elimination of pain;
- Reducing the pathological lordosis in the lumbar spine;
- Elimination of spasmodic contraction of the muscles and scar contractures.
Principles of treatment of listesi 1 degree:
- Permanent peace and a long stay in a horizontal position;
- Exception strong physical exertion;
- Use nonsteroidal anti-inflammatory drugs for pain relief and the elimination of foci of inflammation (diclofenac, Ketorolac, diprospan).
A well-Known scientist and doctor, V. D. Chaklin used for the treatment of patients with displacement of vertebrae special poses. He recommended that when you stay in a horizontal position, bend your knees and lift your upper body. This position you must save as often as possible, within 2-4 weeks.
Bent posture relieves contracture of the musculoskeletal system and facilitates the return of the displaced vertebra to its normal position. While expanding the intervertebral foramen and compression is removed from the nerve fibers.
Stretching on an inclined Board by Andreeva also contributes to unloading of the spinal column. The procedure involves placing the patient on the bench with an inclined Board. The legs tie cargoes in weight of 2-5 pounds. A man flexes the foot in the knee joints and gradually relaxes.
Special physiotherapy is applied simultaneously with the treatment status when spondylolisthesis 1, 2 degrees. It reduces the amount of pathological lumbar lordosis, which is important in the treatment of patients who are "slipping out" of the vertebrae combined with scoliosis (lateral curvature of the vertebral axis).
Corsetteria appointed in listesi 2 degrees. It helps to prevent further displacement of the vertebrae and provides stability to the damaged segment during walking and exercise.
When used surgical techniques
To Treat listes surgical methods are required when the offset exceeds 2 degree, since excessive protrusion of the vertebra in such a situation will lead to spinal cord compression.
The Surgery is performed primarily for decompression of the anatomical structures of the vertebral segments. The second objective in the surgical treatment of displacements of vertebrae – vertebral stabilisation.
up To 30 years of the last century in surgery in order to get to the spine used for rear access. He was very traumatic and was accompanied by a large number of complications such as the occurrence of pseudoarthrosis (formation of false joints).
Professor Chaklin changed surgical tactics in spondylolistheses. Inthe result since 1931 surgeons began to use laminectomy with front access. The graft was placed between the vertebrae, thereby reducing the risk of complications.
Since 1972 for stabilization of the vertebral axis applied to the special clamps. With their help, surgery began simultaneously. That is, all necessary procedures surgeons started within 1 hour without the need for re-intervention after some time.
Metal fixtures are a few of the connecting jaws and hinges with notched floating sponge. The design must be included, base area, which captures the movable body of the vertebra.
The Operation is as follows:
- the Patient placed on a surgical table;
- In the left or right lumbar region cut soft tissue with the introduction of anesthesia
- Taped arteries and veins;
- Fixed the ligaments and muscles, and the damaged region is inserted into a metal locking mechanism;
- optionally, instead of an intervertebral disk is inserted into the graft;
- Close the operational access.
Although spondylolisthesis often leads to disability, timely seeking health care allows physicians to fully restore the functionality of the spine and stably fix the shifted vertebra in correct anatomical position.