Spondylolisthesis is a spinal condition in which one or more vertebrae shift in relation to each other (spondylolisthesis), resulting in a loss of stability of the spine. Depending on the extent and progression of the disease (involvement of the nerves, spinal canal stenosis), spondylolisthesis can generally be treated well within the framework of conservative measures.
What is spondylolisthesis?
In spondylolisthesis, severe back pain is not uncommon. Vertebral slippage or spondylolisthesis is the sliding of a corpus vertebrae (vertebral body) over the vertebral body below it, which can be differentiated according to acquired (wear and tear, trauma, overload) and genetic forms (spondylolysis). The displacement of the vertebrae can occur either forward (ventrolisthesis or anterolisthesis) or backward (retrolisthesis). In most cases, the lumbar vertebrae, especially the 5th lumbar vertebra, are affected by spondylolisthesis, which is often asymptomatic and does not cause any symptoms. Spondylolisthesis may be manifested by load-dependent back and low back pain and a feeling of instability in the affected area. In rare cases, root compression syndrome (irritation of the root of a spinal nerve in the affected spinal area) may be present as a result of narrowing of the spinal canal, leading to neurologic symptoms.
Causes
Spondylolisthesis can be either genetic or acquired. Age-related changes in the spine, particularly in the intervertebral discs, which lose height with age, cause a loss of tension in the ligaments that stabilize the spine. As a result, the vertebral bodies lose stability so that they can shift against each other (degenerative spondylolisthesis). This wear and tear process is favored by insufficient movement and weak trunk muscles. In addition, fatigue lesions or fractures in the pars interarticularis of the vertebral arch as a result of excessive stress on the spine (usually in competitive sports such as javelin throwing, pole vaulting, weight lifting) can lead to spondylolisthesis (isthmic spondylolisthesis). In addition, severe trauma involving injury to the spine or spinal surgery can cause spondylolisthesis (post-traumatic spondylolisthesis). If the spinal column structure is disturbed as a result of a congenital defect in the vertebral arches (spondylolysis), the condition is referred to as congenital or dysplastic spondylolisthesis. In rare cases, spondylolisthesis may be due to a tumor or inflammation (pathologic spondylolisthesis).
Symptoms, complaints, and signs
Spondylolisthesis can cause a variety of symptoms and complaints. However, it is possible that only occasional nonspecific low back pain occurs. These are usually load-dependent in origin. It even happens that a spondylolisthesis is completely symptom-free. In this case, it is often diagnosed only by chance. Whether the freedom from symptoms is maintained over the years, however, is another question. The developing symptoms of spondylolisthesis are caused by the sliding of the vertebrae. There are feelings of pressure and pain in the area of the lumbar spine. These can also radiate into the thigh. In other cases, ischi pain develops. These are often attributed to other events and not necessarily to spondylolisthesis. Occasionally, during the course of spondylolisthesis, there are feelings of tension or muscle cramps in the legs. There, the slipped vertebrae can also become noticeable through muscle weakness. This symptom also does not necessarily indicate spondylolisthesis. Since there are four degrees of severity of slipped vertebrae, the symptoms can be mild, moderate or severe. The symptoms of instability may suddenly worsen under stress. Some symptoms suggest that nerves are involved in the pain. Much more often, however, spondylolisthesis is the cause of other symptoms, for example, following a herniated disc or facet joint arthritis. Both are characterized by severe pain deep in the small of the back.
Diagnosis and course
Spondylolisthesis is usually diagnosed on the basis of an X-ray. Here, spondylolisthesis can be seen in the lateral radiograph in the form of a fixed displacement of the affected vertebral body that is independent of movement.At the same time, statements can be made about the severity of spondylolisthesis (grading according to Meyerding) and changes in the spine (curvatures, joint arthrosis, disc changes, osteoporosis). In addition, computer and magnetic resonance imaging are used to determine soft tissue or nerve involvement. In some cases, congenital spondylolisthesis can be diagnosed at an advanced stage on the basis of the gait pattern (tightrope walk). Spondylolisthesis has a good prognosis depending on the presence of other impairments (nerve involvement, spinal stenosis) and can be well treated with conservative measures if the symptoms are mild.
Complications
Those who have slipped vertebrae also know them by terms such as spondylolisthesis or spondylolisthesis. This acquired disease of the spine usually affects the fourth or fifth lumbar vertebra. Since spondylolisthesis is divided into four degrees of severity – from Meyerding I to IV – complications are not uncommon in higher degrees of severity. One of the most common complications of spondylolisthesis is severe low back pain that defies any physiotherapeutic treatment. In case of such complications, surgical interventions are a solution. In the case of high-grade spondylolisthesis or spondyloptosis with pain lasting more than six months, surgery may be required. Surgical stiffening of the slipped vertebrae is an option. Direct screw fixation of the spondylolysis in the vertebral arch can already be performed in severely affected children. As a consequence of this operation, scarring and nerve injuries may occur. Often, screw fractures occur due to renewed stress on the stiffened vertebral joints. These require further surgery. Acquired instability of the spine can pinch nerves in the spinal canal. In addition, surrounding nerves can become overstretched. Nerve damage or loss of function in the surrounding nerves may occur. As a result of pressure on nerve cords, paralysis is possible. These can affect the legs, but also the bladder and other digestive organs. The sliding vertebrae also cause increasing wear and tear on the affected intervertebral discs and vertebral joints.
When should you see a doctor?
If the affected person complains of pain or irregularity in the back, this should be further observed. If it is a one-time situation of overuse or incorrect loading of the skeletal system, improvements will show within a short period of time after adequate rest and sparing. If after a night’s sleep the patient is found to be free of symptoms, in most cases he or she does not need medical consultation. However, if the discomfort in the back shows a steady increase or continues unabated over a longer period of time, a doctor should be consulted. Restrictions in mobility as well as disturbances in general movement indicate a health disorder. Complaints of the muscular system, feelings of tension as well as a continuous decrease in physical performance should be examined and treated. Although some sufferers experience periods of freedom from symptoms, there is a need for action as soon as a sporadic development of the impairments becomes apparent. If there are feelings of tension or unpleasant sensations when light pressure is applied to the back, a visit to the doctor is necessary. These are warning signals of the organism, for which medical care is indicated. If the affected person has an overall feeling of instability in the area of the spine, a check-up visit to a doctor is advisable. The perceptions should be discussed so that medical tests can be initiated.
Treatment and therapy
In most cases, spondylolisthesis is initially treated conservatively. In this context, conservative therapy aims to reduce the pain present with pain-reducing medications and to strengthen the trunk muscles with physiotherapy, physical therapy, and physiotherapy. For this purpose, the trunk and abdominal musculature is individually trained within the framework of physiotherapy in order to relieve and stabilize the spinal column. For regular exercise, which is a basic component of therapy, back-friendly sports such as cycling, backstroke and Nordic walking are also recommended.In some cases, a corset (Lindemann corset) is also used to stabilize the spine and immediately reduce pain, although this should only be worn for a short time to avoid weakening the trunk muscles. Physical measures such as massages additionally support pain reduction, while back training can contribute to a spine- and disc-friendly gait and everyday behavior. If no improvement in symptoms can be detected after 6 months despite conservative therapy, or if there is nerve involvement or spinal canal stenosis, surgical intervention may be indicated. For example, in the case of spinal stenosis, the spinal canal can be widened in the course of a laminectomy or surgical decompression and the unstable vertebral bodies can be stiffened (spondylodesis). In adolescents with marked congenital spondylolisthesis, the affected vertebra is returned to its original position (reduction) in advance of spondylodesis.
Prevention
Spondylolisthesis can only be prevented to a limited extent. However, a strengthened and trained trunk musculature, everyday behavior that is gentle on the spine and intervertebral discs, and regular exercise help minimize the risk of spondylolisthesis and slow its progression.
Follow-up
Follow-up care plays an important role in both conservative and surgical treatment of spondylolisthesis. Conservative therapy is followed by orthopedic rehabilitation measures, which are supervised by either the patient’s primary care physician or an orthopedic surgeon. Conservative measures are usually considered more promising than surgical interventions. For the follow-up treatment of spondylolisthesis, physiotherapeutic exercises that can be combined with sports activities, relaxation exercises and psychotherapy have proven to be effective rehabilitation measures. The rehab includes an intensive program that takes several weeks. For this, however, the patient must no longer suffer from acute pain. For this purpose, he receives pain medication as well as muscle-relaxing preparations. The freedom from pain means that the patient can move regularly again and exercise his muscles. The focus is on building up the back and abdominal muscles. The cooperation of the patient is also extremely important for the success of the treatment. If the spondylolisthesis has to be treated surgically, follow-up treatment is also necessary. Depending on the extent of the operation, the patient remains in the clinic for about a week. It usually takes twelve weeks before rehabilitation can begin, so that the body has sufficient opportunity to recover. After the stabilizing corset is gradually removed, physiotherapy exercises begin to strengthen the back muscles. Three months after the surgery, there is also a checkup to monitor spinal stability.
What you can do yourself
People with spondylolisthesis (spondylolisthesis) have the opportunity in everyday life to take various measures to reduce their symptoms and prevent the condition from worsening. In many cases, certain types of sport are the trigger for spondylolisthesis, so those affected initially start at this point. It is advisable to reduce the intensity of the sporting activity and to contact a physiotherapist. Even certain exercises before the actual sport can help to reduce the risk of deterioration. In general, it is helpful to seek physiotherapy treatment and strengthen the muscles near the affected section of the spine in a targeted manner and with professional support. This also reduces discomfort and improves the prognosis. The patient, his trainer and the physiotherapist must decide together whether a change of sport is necessary in the individual case. In any case, it makes sense to engage in sports activities that are less stressful on the back, and this usually has a beneficial effect on the patient’s health. Sometimes patients are advised to wear a corset for a while to support the spine. Patients should follow this recommendation in their own interest, even if this means temporary restrictions in everyday life and in the practice of sports.
