Anatomy

The lumbar spine (= lumbar spine) is formed by the five lumbar vertebrae of the spine. Since they are located in the lower part of the spine, they must bear the highest proportion of weight. For this reason, they are also considerably thicker than the other vertebrae.

However, this does not prevent the signs of wear and tear that are particularly common in this area. For example, joint wear and slipped discs are most common in the lumbar spine. The lumbar spine also differs in its structure from the other areas of the spine.

For example, from the second lumbar vertebrae onwards, there is no longer a spinal cord, but only individual nerve roots, which move further down and emerge from the nerve root holes designated for them. This area, where the spinal cord ends and the spinal canal is filled by nerves, is called the “horse’s tail”, or cauda equina in medical terms.

Intervertebral disc (blue)
Vertebral body
Sacrum (red)

The lumbar spine (lumbar spine) is stabilized by the intervertebral discs located between the vertebral bodies and a complex system of ligaments and muscles. The vertebral arch region between the upper and lower vertebral arch joints (interarticular portion) is of particular importance for the clinical picture of adolescent childhood spondylodesis. If there is a zone of bony loosening (lysis zone) in this area, spondylolisthesis may occur.

Cause

Spondylolisthesis can have various causes. A distinction is made between the following causes: In childhood, adolescence and adulthood, spondylolisthesis can be the cause of chronic back pain.

Congenital dysplastic spondylolisthesis (rare)
Childhood/adolescent (isthmic) spondylolisthesis (frequent)
Degenerative, adult spondylolisthesis (frequent)
Posttraumatic spondylolisthesis (rare)
Pathological spondylolisthesis (rare)
Postoperative spondylolisthesis (rare)
More on the topic of spondylolisthesis development

Diagnosis

Spondylolistheses are usually discovered as a random finding in the X-ray image, as they are asymptomatic in most cases. However, they can also be diagnosed by standard x-rays due to back pain, possibly with radiation to the legs or in combination with sensitivity disorders in the lower extremities. If spondylolisthesis is very pronounced, a trunk displacement, also known as ski jump phenomenon, can become conspicuous during the physical examination by the physician.

In any case, imaging examinations, especially x-rays in two planes (lateral and from behind), are necessary to assess the extent of the disease. Since spondylolisthesis often occurs only in a certain posture or position of the affected person, it is advisable to take additional functional images if spondylolisthesis is suspected. In this case, these are x-rays taken while standing in a prophylactic or recoiling position.

The X-ray image will then typically show an interruption of the bony vertebral arch (spondylolysis) and a sliding of the vertebral body backwards or forwards. Depending on the situation, the spinal canal is either widened or narrowed, which may explain some of the symptoms. Usually, the displacement of the vertebral body is accompanied by a degenerated, i.e. worn, intervertebral disc.

In order to enable a more precise assessment of the spinal anatomy, an MRI (magnetic resonance imaging) or CT (computed tomography) can also be applied.A CT is ideal for assessing the condition of the bony structures, whereas an MRI allows the intervertebral discs and nerves to be viewed particularly well. There is currently no valid guideline for the therapy of spondylolisthesis, which is why the current state of studies and/or the physician’s personal experience indicate that treatment is necessary. However, the extent of spondylolisthesis and whether it is a true spondylolisthesis (sliding of a vertebra due to the formation of a cleft vertebral arch) or a pseudospondylolisthesis (sliding of a vertebra despite intact vertebral arches) is important in deciding for or against certain therapy options.

Usually (also due to the unclear study situation) a physiotherapeutic treatment to strengthen the back muscles and reduce the hollow back (lordosis) is initially sought. In addition, painkillers are administered. Pain therapy by injecting local anesthetics into the skin (infiltration therapy) or directly at the nerve root (perdiradicular therapy) is also frequently used.

Medical massages can also reduce the pain. However, the administration of muscle relaxants (drugs to relax the muscles) has not proven to be effective. A regular follow-up is necessary in any case.

Especially in children, the practice of certain sports, such as gymnastics, javelin throwing or swimming (especially the technique of dolphin swimming) can be the trigger of spondylolisthesis. If the disease has already occurred, avoiding these high-risk sports is therefore also part of the therapy. Likewise, monitoring of the course of the disease is even more important in children than in adults, since the risk of severe courses of the disease is higher in children.

A special feature in children is that in some cases healing of spondylolisthesis is achieved by applying a plaster cast or a corset. Finally, the last option to be considered is surgical treatment. This is mainly used if the pain cannot be controlled conservatively (with the above-mentioned methods) or if more serious complications such as nerve damage occur. Here, an attempt is made to return the vertebral body to its physiological position and stiffen it (spondylodesis). This procedure ultimately leads to an irreversible loss of movement in the treated spinal column section.