Lumbar spondylolisthesis is the forward or backward displacement of the upper lumbar spine relative to the lower lumbar or sacral spine caused by abnormal bony connections between the lumbar vertebrae. Nowadays, lumbar spondylolisthesis is one of the common orthopedic diseases, with an incidence of about 5% in the population. In layman’s terms, it refers to the phenomenon of forward dislocation of the upper lumbar vertebrae, resulting in an uneven trailing edge between the upper and lower vertebrae.
What are the causes of lumbar spondylolisthesis?
1. Etiology
(1) dysplasticity (congenital dysplasia of the joint)
(2) isthmic cleft (lumbar spine isthmic defect)
(3) degenerative (degenerative changes in the small joints of the spine)
(4) traumatic (acute fracture of posterior structures near the lumbar isthmus)
(5) pathological (destruction of posterior structures of the spine due to systemic and local bone pathology)
(6) medical (mostly due to excessive removal of bone during decompression).
Among them, degenerative and isthmic cleft slippage accounts for the majority.
2.Grading
Clinically, it is generally graded according to the Meyerding method.
(1) Degree I —- slippage <25%)
(2) II degree – slippage
(3) III degree – slippage
(4) IV degree – slip
(5) V degree – slippage > 100% (lumbar detachment)
Second, what are the signs and symptoms of lumbar spondylolisthesis?
The symptoms and signs of lumbar spine patients are related to the type, degree, age, gender and other factors of the slippage. Generally, there are mainly the following manifestations.
1.Lumbar pain
Long-term recurrent lower back pain, which is aggravated when standing or bending and alleviated when lying in bed. With the increase of age and prolongation of medical history, the condition of most patients will gradually worsen.
2.Leg pain
As the disease worsens, patients will gradually develop symptoms of the lower limbs. It shows unilateral or bilateral radiating pain and numbness in the lower extremities, from behind the buttocks, behind the thighs all the way down to the outer calves, the feet, and even the back of the calves. Sometimes intermittent claudication occurs, and it is necessary to crouch down and rest for a few minutes before continuing to walk. In a few severe cases, there is also weakness of the lower limbs, muscle atrophy, and even incontinence and paralysis of the lower limbs.
3. Physical examination shows an increase in lower back prominence, pressure and percussion pain radiating to the lower extremities, and limitation of lumbar posterior extension activities. The nerve-involved area of the lower extremity is seen to be hyperalgesic, and even the muscle strength is weakened, the Achilles tendon reflex is weakened, and the straight leg raise is limited (positive).
Treatment of lumbar spondylolisthesis
1.Non-surgical treatment: effective for most patients, non-surgical treatment includes bed rest, avoiding participation in activities such as lumbar weight-bearing, twisting and bending with force, reducing excessive lumbar rotation, squatting and other activities, and reducing excessive weight-bearing on the lumbar region. This can reduce the excessive strain and degeneration of the small joints of the lumbar spine and avoid the occurrence of degenerative lumbar spondylolisthesis to a certain extent. Reduce weight, especially to reduce the accumulation of abdominal fat. Excess weight increases the burden and strain of the lumbar spine, especially the accumulation of abdominal fat, which increases the tendency of the lumbar spine to slip forward on the sacrum. Strengthen the functional exercise of the lumbar back muscles. Strong lumbar back muscles can increase the stability of the lumbar spine and antagonize the tendency of the lumbar spine to slip forward.
Exercise of the lumbar back muscles can be used in the following two ways.
One is the prone position, the two upper limbs are abducted, head up, chest up, the upper limbs leave the bed, while the lower limbs are also straightened and lifted backwards in a swallow-like position. The second is supine position, both knees are bent, both feet are on the bed surface, and when inhaling, the chest is lifted and the waist is raised so that the hips leave the bed surface, and the exhalation is recovered. When there are certain lumbar symptoms, lumbar physiotherapy, waist protection, local closure, and taking related drugs are feasible.
2.Surgical treatment: for those who have ineffective conservative treatment, severe slippage, or slippage progression; with persistent nerve root compression and spinal stenosis. The purpose of surgery is to restore the spinal sequence, release the nerve compression, and rebuild the stable spine.
The procedure consists of repositioning the dislocated vertebral body, decompressing the nerve root canal, internal fixation with pedicle screws, and fusion with segmental implants. A large number of clinical cases have confirmed that the results of these procedures are relatively satisfactory, with high patient satisfaction and long-term follow-up results showing good long-term stability, and have become a mature standard procedure.