Lumbar spondylolisthesis refers to the forward displacement of the vertebrae of the lumbar spine, causing compression of the cauda equina or pulling of the nerve roots, resulting in symptoms of lumbar pain or sciatica, and lumbar pain sometimes extending to the buttocks or the back of the thighs. According to statistics, about 5% of the population has lumbar spondylolisthesis, but only a very small number of people will have pain and other symptoms, and only about 10% of them require surgery due to the severity of their symptoms.
The causes of lumbar spondylolisthesis can be roughly divided into five categories, of which the more common lumbar spondylolisthesis for the arch fracture slippage and degenerative slippage: 1.
1, caused by congenital lumbar spine structure abnormalities, usually occurs in the vicinity of the lumbosacral spine.
2, caused by arch root rupture.
3.Degenerative slippage.
4.Traumatic slippage.
5.Pathological slippage.
It may be related to heredity and trauma, and the slippage will be slowed down in adulthood. The chance of slippage in girls is only half of that in boys, but the chance of slippage is four times of that in boys.
Degenerative slippage occurs in middle-aged people over the age of 50 and is about six times more likely to occur in women than in men, and is caused by the long-term degeneration and instability of the lumbar spine joints.
The disease can be diagnosed by plain X-rays or special photographic examinations. X-rays of the lumbar spine can reveal the presence or absence of slippage or the site and extent of slippage. In addition, power radiographs of the lumbar spine can help us further understand the degree of instability, and from a 45-degree oblique film, it is obvious that the arch root is broken, or the small joint surfaces are hypertrophic and loose due to degeneration. When patients have symptoms of nerve compression, further CT, myelogram or MRI can be done to understand the location and severity of nerve compression based on these tests.
Treatment varies according to the degree of symptoms. Patients with milder symptoms that do not significantly affect walking ability may be treated with non-steroidal anti-inflammatory medications and recommended for reduced activity, soft back support or rehabilitative exercise therapy; if the symptoms do not improve with the above conservative treatments (no reduction in pain, significant motor impairment or limited walking ability, and persistent progressive slippage of the lumbar spine), surgical treatment should be considered.
The surgical procedure for lumbar spondylolisthesis includes decompression of the lamina, fusion of the bone graft and internal fixation. The goal of treatment for lumbar spine slippage is twofold: first, decompression surgery to relieve nerve compression; and second, bone graft fusion and internal fixation to obtain stability of the lumbar spine. In recent years, the use of intervertebral fusion (cage) to treat disc degeneration has become increasingly common, and the development of internal spinal fixators has been quite rapid.
In addition to restoring the original height of the intervertebral disc, reducing the pressure on the small joint surface, thus achieving intra-vertebral foraminal decompression and improving the symptoms of spinal nerve compression, it can also increase the stability after implant fusion and internal fixation, reduce the risk of loosening or breaking of the internal fixator, and improve the success rate of osseointegration. Our department generally adopts braced internal fixation to treat lumbar spondylolisthesis, and minimally invasive internal fixation can be used for mild spondylolisthesis to achieve satisfactory results.
The patient can generally go down to the ground 3 days after the surgery, and the activity must be restricted for 3 months, and after 3 months, the activity can be increased in a gradual manner, and after 6 months, the patient can fully resume the free activity. The patient’s age, mobility, good or bad bone quality and whether other serious medical diseases are combined must be considered before surgery. According to our experience, more than 90% of patients can obtain relief of lower limb pain and significant improvement of walking ability after surgery.
Precautions should be taken in daily life after surgery.
1.Avoid stretching, twisting, bending or shaking the back muscles to avoid spraining the back.
2. Use a long-handled broom or mop to do cleaning work, do not bend over.
3.When brushing your teeth and washing your face, bend your knees slightly and do not bend over.
4.Do not lift heavy objects for 3 to 6 months after surgery.
5.Desk work can be done 4 to 6 weeks after surgery, and forceful work can be done only after 3 to 4 months.
6.Increase activity gradually and avoid strenuous exercise.
7.For those who need to wear a hard back brace, they should wear it first before they can get out of bed.
8.Sex life can be resumed after 6 weeks of surgery.
9.Avoid excessive back strain for one year.
10.Maintain proper weight.