What is Lumbar Spondylolisthesis?
The vertebrae that make up the spine in a healthy person are arranged in a regular row on top of each other. Each vertebra is aligned with the vertebrae next to it. The elements that increase the durability and flexibility of this regular structure of the spine and provide mobility are the discs and facet joints. The tissues located in the front of the vertebrae are called discs, while those in the back are known as facet joints.
This structure functions as a kind of bridge or cushion between the bones. The vertebrae extending from the head to the coccyx allow the person to stand upright and protect the spinal cord.
However, in a condition called spondylolisthesis in medicine and known as lumbar spondylolisthesis among the public, one of the vertebrae moves forward and moves out of place. This disrupts the order in the vertebral alignment. This spondylolisthesis causes the spinal cord passing through the spine to become compressed and put pressure on the nerve root.
Lumbar spondylolisthesis can cause complaints such as pain, burning, and numbness in the waist, hips, and legs. And depending on its severity, it can cause more serious problems. Causes of lumbar spondylolisthesis include trauma, degeneration or age-related wear, congenital anomalies, infection, surgery, and tumors. It usually occurs when two vertebrae, called L4 and L5, move forward just above the coccyx. Before examining the diagnosis and treatment methods of lumbar spondylolisthesis, it is important to understand what this condition is.
What are The Types of Lumbar Spondylolisthesis?
Lumbar spondylolisthesis types can be examined in two separate groups as congenital or acquired. In cases of congenital lumbar spondylolisthesis, which is defined as congenital spondylolisthesis, the vertebrae are seen due to developmental disorders.
Although congenital spondylolisthesis cases, which are frequently seen between the L5 and S1 vertebrae, are twice as common in women as in men, only 5% of all lumbar spondylolisthesis cases occur congenitally.
This disorder, which is caused by the weak connection between the two vertebrae, may cause pain in adolescence, which is defined as adolescence, but it may not be a serious problem in adulthood.
In severe cases, symptoms such as severe pain, paralysis in the arms and legs, and urinary incontinence may be seen.
Some of the commonly acquired lumbar spondylolisthesis types are listed below:
Degenerative Spondylolisthesis:
It occurs when the tissues in the spine and its surroundings slide over each other with age. The wear and tear that occurs in the spine and the connective tissues surrounding the spine due to aging is especially seen in people aged 40 and over.
Degenerative spondylolisthesis cases are usually accompanied by narrow canal disease. In addition to back and leg pain, symptoms such as numbness and weakness in the legs, difficulty in walking, and increased lumbar curvature are among the most common complaints in this disorder. An increase in complaints may be observed during physical activities such as standing and walking.
Spondylolysis:
A fracture occurs due to excessive load on the lumbar region, which is more mobile than the upper part of the body.
In the presence of this condition, also known as a stress fracture, the vertebrae located in the upper part slide downwards.
And in cases of lumbar slippage that develop due to a stress fracture that does not show symptoms during rest, the first symptom is low back and hip pain.
In some cases, symptoms such as a feeling of tension in the muscles, weakness, numbness in the legs and difficulty walking may be observed.
However, stress fractures, which mostly do not show any clinical symptoms, are usually seen during radiological imaging performed for different reasons.
Traumatic Spondylolisthesis:
In cases of acute traumatic spondylolisthesis due to accidents, the pain increases while standing and with movement. The severity of the pain in the area of the trauma and other neurological symptoms it shows vary according to the extent of the trauma.
The cause of the pain is mostly seen as degeneration in the discs located between the vertebrae or, in other words, the failure of the disc structure to fulfill its function due to deterioration.
Another cause is facet arthrosis, which is seen due to the fragmentation of the facet joint located between the vertebrae due to trauma.
Why Does Lumbar Spondylolisthesis Occur?
Lumbar spondylolisthesis usually occurs due to five main reasons:
These are;
- Degenerative,
- Isthmic,
- Dysplastic,
- Pathological and Traumatic.
In Degenerative Spondylolisthesis:
There is no disorder in the facet joints that connect the lower and upper vertebrae.
The main reason here is the wear and tear in the tissues that develop due to aging.
It may be related to the senile degeneration of the combined facet and discs.
It may cause the vertebrae to move forward due to the imbalance of one vertebra to the other.
And it is usually seen over the age of 40. It occurs more frequently in women.
In Isthmic Spondylolisthesis:
There is a disorder in the facet joints at the back of the vertebrae. Although the main reason for this type is not exactly known, a possible reason is the micro trauma that occurs in individuals who are involved in sports such as gymnastics, football and wrestling that stretch the lumbar joints.
Dysplastic Spondylolisthesis:
It is congenital and occurs due to an abnormal alignment in the facet joints.
Pathological Spondylolisthesis:
It occurs due to reasons affecting many organs of the body such as disorders in bone and connective tissue or due to infection. In addition, it can also be caused by neoplasm (newly formed tissue, tumor) and iatrogenic (man-made) processes, which are unwanted conditions after treatment.
Traumatic Spondylolisthesis:
It often occurs as a result of trauma and occurs due to facet joint fractures.
An additional risk factor for spinal spondylolisthesis is genetics. The presence of spinal spondylolisthesis, scoliosis and hidden spina bifida in first-degree relatives should be considered.
Other Factors:
- Obesity,
- Low Muscle Tone,
- Smoking Habit,
- And Poor Posture
also increase the risk of lumbar spondylolisthesis.
Who Gets a Slipped Lumbar Spondylolisthesis? Who’s at Risk?
Lumbar Spondylolisthesis is most commonly seen in older adults.
However, the following groups are at higher risk for a slipped lumbar spine:
Athletes:
Slipped lumbar spine is common in young athletes. This can occur due to increased pressure on the spine from overexertion or injury.
Obese People:
People who are overweight are at higher risk for slipped lumbar spine because they put more stress on the spine in the lumbar region.
Genetic Factors:
Slipped lumbar spine is more common in people with a family history of the condition.
Osteoporosis:
Loss of bone density weakens the spine. And can cause lumbar spondylolisthesis.
Pregnant Women:
During pregnancy, the pressure on the spine increases due to the effects of hormones in the body, and the risk of slipped lumbar spine can increase.
People with slipped lumbar spine can be treated according to the recommendations of their doctors, depending on the severity of their symptoms. Physical therapy, painkillers, steroid injections or surgery can be used.
What are The Symptoms of Spondylolisthesis?
The symptoms of spondylolisthesis vary depending on the location of the spondylolisthesis, its size, and how much pressure it puts on the nerve roots.
But the common symptoms of spondylolisthesis can be listed as follows:
Lower Back Pain:
The most common symptom of lumbar spondylolisthesis is pain in the lumbar region. This pain can sometimes be sharp and severe. It can start from the lumbar region and spread to the hips or legs.
Leg Pain and Numbness:
Due to the lumbar displacement, pressure occurs on the nerve roots. Pain, burning, numbness or tingling sensations may be experienced in the legs. These pains usually spread to one leg. And increase with leg movements.
Muscle Weakness:
Another condition caused by spondylolisthesis pressing on the nerve roots can be muscle weakness in the legs. The resulting muscle weakness can affect your ability to walk or stand.
Urinary and Defecation Problems:
Although rare, spondylolisthesis can seriously compress the spinal cord and cause problems with urination or defecation control. In this case, emergency medical intervention is usually required.
Inflammation and Swelling:
Irritation of the surrounding tissues as a result of the slippage of the vertebral disc can lead to inflammation and swelling in the area.
Pain When Moving:
Pain may increase during movements that strain the back, especially sitting for a long time or bending forward.
Tenderness:
You may feel tenderness or pain when the area with the slippage is touched.
How is Lumbar Spondylolisthesis Treated?
The basic treatment for spondylolisthesis is conservative. (Non-surgical Treatment). The main treatment methods are restriction of movement that increases pain and displacement, weight loss, painkillers, use of corsets, and physical therapy applications. 10-15% of cases do not respond to conservative treatment and require surgical intervention. In those with a degree of displacement above 50%, surgical treatment may be required to stop the progression of neurological deficits, stabilize the lumbar spine, and restore spinal integrity.
What are The Non-Surgical Methods for Lumbar Spondylolisthesis?
Spondylolisthesis is a condition that occurs as a result of the displacement of the disc between the two vertebrae at the lowest part of the spine. Lumbar displacement can cause symptoms such as pain, numbness, tingling, and loss of strength.
Non-surgical methods for spondylolisthesis are the first treatment option for most patients. These methods help reduce pain and inflammation, support the spine, and strengthen the muscles.
Nonsurgical methods used to treat lumbar spondylolisthesis include:
Rest:
People with spondylolisthesis should rest until the pain and swelling subside. This period can usually range from a few weeks to a few months.
Painkillers:
Painkillers can help reduce pain and inflammation.
Physical Therapy:
Physical therapy helps strengthen the muscles and support the spine. Methods used in physical therapy include stretching exercises, strengthening exercises, massage, and hot and cold applications.
Corset:
A lumbar corset helps support the spine and can reduce pain.
Injections:
In some cases, steroid injections can be used to reduce pain and inflammation.
How is Lumbar Spondylolisthesis Surgery Performed?
Lumbar spondylolisthesis surgery is a serious surgical operation performed under general anesthesia. The number of hours that lumbar spondylolisthesis surgery takes may vary depending on the degree of lumbar spondylolisthesis.
There are two types of methods used for lumbar spondylolisthesis surgery.
These methods can be listed as follows:
Open Lumbar Spondylolisthesis Surgery:
In this lumbar spondylolisthesis surgery method, an incision of approximately 10-15 cm is made in the lumbar spondylolisthesis region of the spine. By entering through this incision, the lumbar spondylolisthesis region of the spine is opened and the lumbar spondylolisthesis that occurs can be corrected. In some cases of lumbar spondylolisthesis, screws, bone grafts or other types of implants can be used to correct the lumbar spondylolisthesis.
Closed Surgery:
In this lumbar spondylolisthesis surgery method, several small incisions (approximately 1-2 cm) are made in the lumbar spondylolisthesis region of the spine. By entering through the incisions, the lumbar spondylolisthesis region of the spine is opened with the help of imaging systems and the lumbar spondylolisthesis is corrected. Screws, bone grafts or other types of implants can be used to correct the lumbar spondylolisthesis.
What are The Risks of Lumbar Spondylolisthesis Surgery?
The vast majority of patients do not experience the medical problems we define as complications after lumbar spondylolisthesis surgery. However, knowing what the risks are is important for both the patient and the surgeon.
Possible risks of lumbar spondylolisthesis surgery are as follows;
Infection
The risk of infection is higher in surgeries performed with open methods, especially compared to surgeries performed with fully closed methods.
Bleeding
The risk of bleeding is also higher in surgeries performed with open methods, as in the case of infection, compared to surgeries performed with fully closed methods.
Spinal Cord or Nerve Injury
The most important and feared risk of lumbar spondylolisthesis surgery is spinal cord and nerve injury. Nerve tissue injuries usually develop due to the removal of pressure on the nerve tissue and the failure of the screws placed in the spine to be placed into the bone as they should be. In this regard, the experience of the surgeon on the one hand and the quality of the x-ray systems used for control purposes while the screws are placed on the other hand are important.
Spinal Cord Sac Rupture and Cerebrospinal Fluid Leakage
Spinal cord sac injuries that are detected and repaired during surgery do not cause problems if the nerve fibers in the sac are not damaged. Small injuries can sometimes close on their own. Large spinal cord sac injuries that do not close on their own form a cyst due to the continuous leakage of cerebrospinal fluid out of the sac. In this case, the sac usually needs to be repaired with a new surgery.
Loosening or Breaking of Screws
Breaks can occur in the screws placed in the spine due to mechanical problems. The screws can also loosen and cause pain.
Lossing of Bone Graft
If the graft placed between the vertebrae is exposed to a high and unbalanced load before union occurs, it can move out of place, put pressure on the nerves and cause pain or other problems.
Inadequate Fusion (Pseudoarthrosis)
If the graft placed between the vertebrae does not fuse as expected in this area, a false and mobile joint tissue may develop.
Wear and Tear of Adjacent Levels
Even if the area where the spondylolisthesis is located has been surgically treated correctly enough, fixing this level and completely restricting its movement may cause the movement to be shared between the upper and lower levels, placing more load on these levels and causing them to wear out more easily. Degeneration may occur in the disc joints above or below the fusion created by the spondylolisthesis surgery.
If the worn level becomes unstable and painful later on, another surgery may be required to fuse this area as well.
Formation of Blood Clots and Development of Embolism
Therefore, on the one hand, it is necessary to ensure that the patient moves in the early period after the surgery, and on the other hand, if early movement is not possible, it is necessary to start using blood thinners for protection.
The risks of lumbar spondylolisthesis surgery increase in surgeries performed in hospitals that do not have sufficient experience or do not have sufficient medical infrastructure.
