Spondylolisthesis causes

In a healthy spine, this forms a uniform S-curve (physiological lordosis and kyphosis). The individual vertebral bodies sit firmly one on top of the other and are attached and reinforced by joints, ligaments and muscles. Spondylolisthesis is the slippage of one or more vertebrae of the spine.

In most cases, the vertebrae shift forwards, but they can also slide backwards or sideways. The vertebrae of the lumbar spine are more frequently affected by spondylolisthesis than those in the lower back. Since the vertebral bodies are connected by joints, a slipped vertebra often involves several vertebrae. This results in instability of the spinal column.

Classification

Spondylolisthesis can be classified into different degrees of severity. In grade I, less than 25% of all vertebrae are displaced and no or hardly noticeable complaints occur. This symptomatology is also found in grade II, although 25 to 50% of the vertebrae can be affected. In grade III, 51 to 75% of the vertebral bodies may have shifted, which leads to severe symptoms in the affected person. The course is similar in grade IV, in which more than 75% of the vertebrae slip away and can lead to considerable problems.

Causes

Responsible for the spondylolisthesis are first of all degenerative changes in the different joints. This is especially true for the joints that connect the adjacent vertebral bodies above and below each other. Due to the strong overloading, the bone is gradually worn out and friable.

As a result, a gap can form between the vertebral bodies. The formation of this gap is known in technical terminology as spondylolysis. The resulting loosening of the vertebra in its anchorage allows it to slide forward.

It is not uncommon for several vertebrae to slip forward. Factors such as shape, composition and advanced changes in the associated intervertebral disc can promote this process. Wear and tear and the resulting loss of bone substance is the most common reason for the occurrence of spondylolisthesis in old age.

Affected are often people at the age of 50 and 60 years. With increasing years of life, the intervertebral disc loses fluid and thus also its effect as a shock absorber. The surrounding musculature decreases in strength and can no longer stabilize the spine sufficiently.

Much rarer causes can be inflammations, injuries or tumors of the spine. In addition, there are some sports that can trigger spondylolisthesis. In competitive sports, for example, these include disciplines such as apparatus gymnastics, trampoline jumping or pole vaulting as well as the various throwing disciplines.

The overstrain is then very large. Spondylolisthesis can also be genetically determined if a certain instability of the spine has been present since birth, which can be caused by malformations such as the absence of bony protrusions on individual vertebrae. Patients’ symptoms depend on the severity of the spondylolisthesis and the extent of the degenerative process of the affected vertebral joint surfaces.

If less than 50 percent of the vertebrae have slipped, patients often feel no pain. In many cases, spondylolisthesis is then diagnosed only by chance. There is a difference between congenital and acquired spondylolisthesis.

Patients who have been known to suffer from spondylolisthesis since birth often have the first symptoms at an early age. On the other hand, in the acquired case, the symptoms appear quite late and the cause remains undiscovered for a long time. There are no characteristic symptoms of spondylolisthesis.

Pain manifests itself as unspecific back pain. These occur particularly suddenly during movement, and can spread in a belt-like manner from the back to the front in the direction of the abdomen. Patients often report an increase in pain during stretching of the back.

Additional problems can occur when the slipped vertebra presses on nerves and pinches them. The patient may then experience sensory disturbances and muscle weakness in the legs. If such a more serious symptomatology occurs, treatment should be initiated immediately to avoid a worsening or even permanent damage.