Spondylolisthesis

Synonyms

Spondylolisthesis, vertebral slippage, slipped vertebra, degenerative spondylolistesis, degenerative spondylolisthesis, congenital spondylolistesis, congenital spondylolisthesis, back pain

Definition Spondylolisthesis

A spondylolisthesis/spondylolisthesis refers to a slippage of the vertebral body. The lumbar spine is almost always affected. Congenital and acquired forms of spondylolisthesis are known.

Among the common causes of spondylolisthesis, a child/young form can be distinguished from a wear-related (degenerative) adult form. In the infantile/adolescent form, an interruption of the vertebral arch (spondylolysis) causes instability of the vertebral bodies among themselves. The lowermost vertebral body section (segment) of the lumbar spine, lumbar vertebral body 5 to sacral body 1 (L5/S1), is particularly affected.

In this case, the vertebral body arch of L5 is affected and can slide forward over the sacrum towards the abdominal cavity (ishmic form of spondylolisthesis). The adult form of spondylolisthesis is part of the degenerative spinal diseases of the back. The vertebral body section lumbar vertebral body L4 to lumbar vertebral body L5 is particularly affected.

There is no lysis zone (interruption of the vertebral arches). The cause of spondylolisthesis is degenerative instability resulting from a reduction in the height of the intervertebral disc between L4 and L5 and a general structural loosening of the stabilizing segmental structures (ligaments, muscles, etc. ).

Spondylolisthesis vera

Spondylosthesis vera or ‘true spondylolisthesis’ describes the sliding or slipping of a vertebra forward, probably caused by a congenital disorder. In this clinical picture, the vertebral arches (spondylolysis) are malformed during development in the womb. The exact causes of this malformation (dysplasia) are still unknown.

Theories look for the reason in the evolution of the upright gait, when man rose from the four-footed position to his two legs. Thus, spondylolisthesis vera can be clearly distinguished from vertebral displacements without gaps in the vertebral arch. These include degenerative spondylolisthesis (pseudospondylolisthesis), retrolisthesis (sliding of the vertebrae backwards), rotational sliding and spondylolisthesis as a result of osteoporosis, tumor, inflammation, fracture, etc.

At the beginning of spondylolisthesis vera, the defect is located in the vertebral arch. In most cases, this is not completely formed from bone, but is interrupted by a connecting piece of softer material, such as cartilage. It is not uncommon for the defective piece to be elongated.

Due to the increasing strain on the back, the soft cartilage dissolves over time. The interruption of the arch is then usually found in the area between the upper and lower joint process (interarticular portion) and on both sides. This means that stability in the spinal column is no longer guaranteed.

As a result, the corresponding vertebral body slides forward (abdominal = ventral), including the part of the spinal column above it. In many cases, spondylolisthesis vera proceeds without symptoms. Typically, it is discovered by chance in young adults during an X-ray examination.

It is relatively widespread among the population (2-4%)! In children, however, there is a risk of further massive slippage of the vertebrae during growth, so that severe back pain and even neurological deficits are possible. If a painful spondylolisthesis vera is considered to be confirmed, painkillers can be administered symptomatically.

In addition, the abdominal and back muscles should be strengthened through physiotherapy. Under certain circumstances, a supporting bandage or corset can also help. Nevertheless, it should be emphasized that spondylolisthesis is often painless! As long as there is no pain, treatment is not necessary.