As the name implies, lumbar spondylolisthesis is a misalignment between the lumbar vertebrae, generally based on the inferior vertebrae and divided into: anterior, posterior and left-right slippage according to the direction of the superior vertebrae sliding. The most common one is anterior slippage. The spine is composed of several vertebrae in series, and the lumbar spine includes 5 vertebrae, which is the largest part of the whole spine, plus between the lumbar 4 and 5 vertebrae is the apex of the lumbar physiological pronation, and the shear force between the lumbar 4 and lumbar 5 is the largest, so lumbar slippage usually occurs between the lumbar 4 and lumbar 5, which we call lumbar 4 slippage. Good! Let’s take lumbar 4 slippage as an example. The lumbar 4 vertebra is displaced forward relative to the lumbar 5 vertebra, and if the anterior and posterior diameters of the lumbar 5 vertebra are equally divided into 4 equal parts, each slipped part is one degree, a total of four degrees, and the symptoms and hazards of lumbar spondylolisthesis are gradually increased step by step. The main hazards of lumbar spondylolisthesis are as follows: 1, lumbar 5 is the tail section of the entire spine, like the first floor of a skyscraper, lumbar 4 vertebrae is like the second floor, is the building’s most loaded floor, and it is precisely this place out of order, the second floor relative to the first floor to the side of the shift, it is conceivable that the building will become shaky, the same reason the entire spine will also be because of the lumbar 4 vertebrae forward slip, and become the center of gravity Unstable, every time the waist force, the waist 4 and 5 will slide between each other, resulting in the waist can not bear weight, the sense of foreign movement, pain. 2, the foundation is unstable, over time, the other vertebrae above will also have problems between the first affected lumbar 34 intervertebral space, because between the lumbar 45 is not the normal trajectory of movement, the normal trajectory between the lumbar 34 will also become abnormal, manifested as lumbar 34 disc degeneration accelerated. 3. Not only the adjacent intervertebral spaces are affected, but also the distant spaces cannot avoid being victimized. Clinically, it is often seen that because of the slippage of the lumbar 45 gap, serious spinal deformities such as scoliosis and kyphosis between the above vertebrae slowly appear. We often say that the upper beam is not correct, but here is the foundation is not correct upper beam more crooked ah. 4, slippage leads to misalignment between the vertebrae will produce shear extrusion on the nerve. When the vertebrae are aligned neatly, the vertebral holes are connected to form the largest diameter of the spinal canal, when the lumbar 4 vertebrae slip forward, the nerves in the lumbar 4 and lumbar 5 vertebral foramina have nowhere to go but to be compressed by the various structures of the misalignment, especially the lumbar 4 nerve roots walking in the lumbar 4 and 5 intervertebral foramina are tightly squeezed by the four walls of the stretched and deformed narrow intervertebral foramina. This compression is still changing, and the dynamic stenosis caused by slippage has an impact on the nerve, and the vertebrae keep changing position as the body moves, slipping, resetting, slipping again, and resetting again. It is like the waves constantly impacting the beach, even hard stones are polished off their corners and become rounded and smooth. Another example of impact damage, house renovation in a solid reinforced concrete wall drilling, will use the impact drill, that is, the drill bit in the rotation at the same time there is a constant forward and backward movement, so as to turn out of the hole. As you can see, the impact injury is greater than the normal compression injury. Unfortunately, the nerve tissue is very delicate and not regenerative and cannot withstand such an impact injury. Clinically, the degree of nerve damage in patients with lumbar spondylolisthesis is generally more severe. So why does a slippage like this happen? The answer is that something is wrong with the structures that limit the forward sliding of the vertebrae. The anatomical structure between the vertebrae is briefly described. The soft tissues that connect the two adjacent vertebrae to each other are: the anterior and posterior longitudinal ligaments, the ligamentum flavum, the interspinous ligament, the supraspinous ligament and the fibrous ring of the intervertebral disc; the hard ones are only the synovial joints. Soft tissues are limited even by the strong disc restriction force. The key is the hard structure, the articular eminence joint, which allows a range of motion between vertebrae but also limits excessive motion and vertebral misalignment. The synovial joint consists of the inferior synapse of the superior vertebral body and the superior synapse of the inferior vertebral body, where the inferior synapse is connected to the entire vertebral body via the “isthmus” of the vertebral plate, which is very critical. There are two types of problems with the isthmus, one is the lengthening of the isthmus due to stretching forces during development, and the other is the fracture of the isthmus. When the isthmus is elongated, the vertebral slippage is usually not serious, mostly one degree, which we call pseudoslipping, and most patients can be treated conservatively. In patients with isthmus rupture, it can be congenital dysplasia or an acquired rupture under long-term stress concentration, either of which can lead to severe misalignment between vertebrae, which we call true slippage, and this is an absolute indication for surgery. How is lumbar spondylolisthesis treated? Note that the word “symptoms” is added here, meaning that lumbar spondylolisthesis leads to clinical symptoms. The process of lumbar spondylolisthesis from emergence, development, to aggravation is also a process from quantitative change to qualitative change. When the spondylolisthesis starts, there are no obvious symptoms, and the patient is not even aware of it, and only later do symptoms such as lumbar discomfort, pain, severe pain, and nerve damage gradually appear. By the time the patient goes to the hospital because of pain, the lumbar spondylolisthesis has actually changed from the compensated stage to the decompensated stage, that is, it has become serious to a certain extent. Whenever I see such a patient, the first thing I consider is the severity of the patient’s clinical symptoms, back pain and nerve damage as the main basis for conservative and surgical treatment. It is important to emphasize here that the main basis and goal for a doctor to recommend surgery is the patient’s symptoms, and that surgery and various treatments are taken to relieve the patient’s pain, not to make the images on the imaging film look good. When the back and leg pain caused by lumbar spondylolisthesis seriously affects the patient’s life, and after strict conservative treatment has no obvious effect, surgery should be taken. If the patient has a true slippage, that is, a lumbar slippage with isthmus cleft, surgery should be taken more actively because the true slippage is serious and deteriorates rapidly, and only surgery can finally solve it. The principles of surgery for lumbar spondylolisthesis can be summarized in eight words: “decompression, repositioning, fusion, and fixation”. Decompression is to relieve the nerve compression, repositioning is to pull the slipped and displaced vertebra back to its normal position, fusion is to fuse the repositioned vertebra with bone graft to ensure that it does not slip again, and fixation is to provide immediate stability to the spine to reduce bed time and ensure that the intervertebral bone graft heals smoothly. Today’s spine surgeons are fortunate to have a powerful tool for posterior spinal lift and fixation and fusion – the pedicle screw endospinal fixation system. With the help of this system, spine surgeons are able to perfectly perform the eight words of lumbar spondylolisthesis surgery: decompression, repositioning, fusion, and fixation. In this sense, patients with lumbar spondylolisthesis are now relatively fortunate: when we cannot choose what disease we have, we should be grateful that there is a treatment for the disease we have.