Spondylolisthesis is the partial or complete sliding displacement of the upper lumbar vertebra from the surface of the lower vertebral body due to the loss of connection between the isthmus of the upper and lower articular processes of the lumbar vertebral arch, resulting in back and leg pain as the main clinical manifestation. killan introduced the name of spondylolisthesis in 1854, which is mainly due to the loss of stability of the lower articular processes of the upper vertebral body due to the lesion of the isthmus of the lumbar arch. The main cause is the loss of stabilization of the inferior articular process of the superior vertebral body due to lesions in the isthmus of the lumbar arch, resulting in slippage of the vertebral body, followed by the clinical manifestations of cauda equina and nerve root compression. The incidence of this disease is about 5% in the population, and it is one of the causes of low back pain, mostly in the 5th and 4th lumbar vertebrae, accounting for about 95% of the cases, with more men than women. Etiology Chinese medicine believes that this disease is mainly caused by lumbar and leg pain, which is related to the deficiency of kidney energy and strain and injury. After the disease is established, the paralysis, numbness and weakness of the lower back and legs are the evidence of deficiency of the root and the symptoms. The deficiency of kidney qi, the lack of essence to nourish the bones, and the degeneration of the bones; at the same time, the misalignment of the bones in the lumbar region, the internal obstruction of blood stasis, and the obstruction of the Qi and blood of the channels of the Governor’s vein and the bladder. Modern medicine believes that collapse of the vertebral arch root isthmus is the main cause of lumbar spondylolisthesis, and the collapse of the vertebral arch root isthmus is related to congenital isthmus insufficiency, acquired chronic strain or violent injury. In addition, middle-aged and elderly patients are prone to lumbar instability and spinal slippage due to degenerative disc degeneration, narrowing of the intervertebral space and laxity of the intervertebral ligaments, with a normal isthmus and no disintegration, in addition to degenerative slippage, which is not discussed in this section. After isthmic fracture occurs, the upper articular process, transverse process, vertebral arch root, and vertebral body as the upper part, and the lower articular process, vertebral plate, and spinous process as the lower part, there is no normal bony connection between them in the isthmus, forming a pseudo-joint, and its gap is filled with fibrous connective tissue and cartilage-like tissue, and abnormal activity occurs at the vertebral arch and the lumbar body slides forward when the lumbosacral region moves, which also leads to degeneration of the intervertebral disc, fibrocartilage-like hyperplasia in the isthmus of the vertebral arch and These pathological changes can stimulate and compress the nerve roots, resulting in lower back pain and lower limb pain. If the slippage is obvious, it can also compress the cauda equina nerve and cause symptoms and signs of cauda equina injury. There are, of course, a few cases in which lumbar spine slippage exists but there is no discomfort. The lumbar slippage occurs mostly in lumbar 5, followed by lumbar 4, and degenerative slippage can occur in lumbar 3. The slipped vertebrae slide forward and form a ladder at the posterior edge of the adjacent vertebrae, directly compressing the cauda equina; the supra-articular synapses of the slipped vertebrae move forward and protrude into the superior intervertebral foramen, causing the foramen to narrow and compressing the nerve tissue; the fibrous tissue proliferation after the injury of the vertebral arch also causes compression and irritation to the peripheral nerves: degenerative degeneration with spinal stenosis The intervertebral disc degeneration. Clinical manifestations and diagnosis I. Symptoms The main symptom is lower back pain, sometimes accompanied by pain in the buttocks and legs. The pain is related to the activities of the lumbar spine, and it increases when the lumbar load is increased and decreases when lying down. There may be periods of remission. Low back pain is intermittent at first, but later it can be persistent, seriously affecting normal life and cannot be relieved by rest. In case of combined lumbar disc herniation, the patient may show sciatica symptoms. Second, physical signs Usually the patient’s physiological curvature increases, there may be pressure pain in the spinous process, interspinous process or paraspinous process, obvious steps may be palpated, lumbar forward flexion may be unrestricted, there may be hypotonia and mild to moderate muscle atrophy of the lower limbs on one or both sides. The muscle strength and sensation in the area innervated by the affected nerve roots may be reduced, and those with cauda equina injury may have perineal palsy and anal sphincter relaxation. Laboratory and other examinations I. X-ray examination Frontal and lateral and oblique views of the lumbosacral segment. It can show the lumbar isthmus crack, intervertebral slippage, width of the vertebral space, and osteophytes. Lateral films are an important diagnostic tool to observe and measure the extent of slippage. The commonly used method is the Meyerdin method. The anterior and posterior diameters of the upper edge of the inferior vertebral body are divided into four equal parts, and a straight line is drawn from the posterior edge of the slipped vertebral body to the angle of intersection with the upper edge of the inferior vertebral body, and the result is measured as IО if the anterior displacement is within 1/4, mostly between IО and IIIО. Those with more than 3/4 are considered IVО, and those with complete dislocation from the inferior position are considered total dislocation. The oblique sign clearly shows the image of the isthmus of the vertebral arch, and the image of the arch of the vertebral arch in the oblique position is dog-shaped, with the dog neck referring to the isthmus. If there is no fissure in the isthmus, the isthmus may also appear to be elongated, and the lower articular processes of the vertebrae above and the upper articular processes of the vertebrae below are close to the isthmus, which seems to have a tendency to cut off the “neck”, which is called the pre-collapse sign of the vertebral arch. Lumbar hyperextension and hyperflexion X-rays can show further displacement changes of the slipped vertebral body with the change of position. Second, the vertebral canal imaging, CT, MRI examination vertebral canal imaging can clearly show the narrowing of the spinal canal, the dural sac compression, slippage is obvious iodine column shows a step, sometimes interrupted. CT can also show the stenosis of the spinal canal and the bulging discs of the affected segments, and MRI can help determine the extent of decompression and fusion by observing the compression of lumbar nerve roots and the degree of degeneration of each disc. Clinical diagnosis relies on symptoms, signs and radiographs, especially the right and left oblique films of the lumbar spine, which are usually not difficult. It is necessary to clarify (1) the relationship between the collapse of the vertebral arch, spinal slippage and lumbar pain, and whether they are the cause of lumbar pain; (2) whether there are symptoms of nerve root or cauda equina nerve compression. It is also necessary to differentiate from other diseases of the lumbar region that can cause low back pain and lower limb radiating pain, such as lumbar disc herniation, lumbar spinal stenosis, acute and chronic injury of lumbar muscle, intravertebral canal tumor, and polyneuritis. In addition to clinical symptoms, the presence of isthmic fissure and vertebral segment slippage on X-ray is a distinguishing feature. Treatment A significant proportion of people with isthmic fissure and degree I slippage are asymptomatic and do not require treatment, but they need to avoid heavy physical work and strengthen abdominal muscle exercise. Non-surgical treatment is used for mildly symptomatic degree I slippage. If it is accompanied by obvious lumbar pain and abnormalities in the innervation area, surgical treatment is required. (1) Kidney essence deficiency. Soreness in the lumbar region, weakness in the legs and knees, worse with strain, relieved when lying down, shortage of breath, and muscle C-cutting. Pale tongue, thin coating, sunken pulse. The treatment is to tonify the kidney and benefit the essence, and the formula is Zuo Gui Wan with addition and subtraction. (B) Phlegm-damp paralysis. Soreness and swelling of the waist and legs, sometimes light and sometimes heavy, restlessness, aggravated by cold, relieved by heat and pain. Pale tongue, white smooth coating, sunken and tight pulse. Treatment is to remove dampness, resolve phlegm, warm the meridians and clear the channels. This formula is based on the addition and subtraction of Living Parasite Tang. (C) Qi deficiency and blood stasis. Low back pain with indolent sitting, numbness, inability to walk and stand for long periods of time, muscle maltreatment, less florid face, fatigue. The tongue is stagnant and purple, with thin coating and tight pulse. Treatment is to benefit Qi and nourish Blood, invigorate Blood circulation and remove blood stasis. The formula is to add and subtract the tonic Yang Returning Five Soup. Second, the manipulation treatment manipulation has the effect of promoting local qi and blood flow, relieving muscle spasm and rectifying lumbar spondylolisthesis. However, the technique must be gentle and gentle, light and steady, with appropriate strength, avoid strong pressure and twisting the waist, so as not to cause more serious damage. Applicable to I degree lumbar spondylolisthesis or degenerative spondylolisthesis. The pathological changes of lumbar spondylolisthesis caused by lumbar spondylolisthesis are irreversible, and the pain can be partially relieved by non-surgical treatment, but quite a few patients can only be relieved for a short period of time, and the spondylolisthesis may be aggravated with the passage of time, along with the narrowing of the spinal canal and nerve root outlet is also aggravated, sometimes causing persistent nerve pulling and compression, and the symptoms cannot be relieved, so surgery is needed to The symptoms cannot be relieved, and surgery is required to solve the problem. The principles of surgery are decompression, repositioning, fusion and stabilization of the spine. (I) Indications for surgery (1) adolescents with no or symptomatic slippage greater than 50% and in the growth phase; (2) those with progressive slippage; (3) those with spinal deformities and significant gait abnormalities that cannot be corrected by non-surgical treatment; (4) those whose pain cannot be relieved by non-surgical treatment; (5) those with neurological symptoms or cauda equina compression syndrome in the lower extremities. (2) Surgical methods 1, laminectomy decompression For nerve root or cauda equina nerve compression and combined with disc herniation, spinal fusion should be performed at the same time to prevent the vertebral body from slipping forward. 2, isthmus direct repair implant internal fixation Suitable for young patients with arch collapse or collapse slippage within I degree, and no symptoms of nerve damage. 3.Spinal fusion is divided into posterior, intervertebral, and lateral-posterior intertransverse process bone graft fusion. Prevention and conditioning Lumbar spondylolisthesis is based on congenital abnormalities in the development of the isthmus of the vertebral arch, due to fatigue fractures and chronic strain, so the prevention of lumbar spondylolisthesis is mainly to avoid trauma, especially for certain manual workers and athletes, regular health checkups and preventive education should be carried out, and more attention should be paid to athletes in projects with more lumbar back extension, and the function of the lumbar back muscles and abdominal muscles should also be strengthened Exercise, etc.