We refer to this movement and misalignment between the lumbar vertebrae as “lumbar spondylolisthesis”. Among the many causes of lumbar pain, one is a problem in the alignment of the adjacent lumbar vertebrae. As we know, under normal circumstances, the lumbar spine is straight from the front, while from the side, the lumbar spine presents a forward harmonious arc. There are five lumbar vertebrae, which are neatly aligned with each other. In some cases, there is a “misalignment” between the lumbar vertebrae (this misalignment is often the upper lumbar vertebrae slide forward), we call this movement and misalignment between the lumbar vertebrae “lumbar spondylolisthesis”. Common causes 1. Genetic factors The arch collapse may have a certain genetic predisposition. Some patients are born with fragile vertebral arch isthmus, so it is especially easy to break, plus the acceleration of growth and development in adolescence, which contributes to the occurrence of lumbar spondylolisthesis. 2, strain certain sports, such as gymnastics, weightlifting and soccer, etc., on the lumbar spine arch isthmus caused by regular repetitive stress; in addition, the movement of the lumbar spine in the process of continuous hyperextension is also a bad stress, the combination of these factors will eventually cause one and bilateral arch isthmus fracture. 3, degenerative changes Degenerative changes in the lumbar spine can cause narrowing of the lumbar spine gap, instability and overactivity of the small intervertebral joints, and greatly increased stress on the vertebral arch isthmus. Other factors, such as cerebral palsy, are also possible causes of lumbar spondylolisthesis. In adolescents, the most common clinical cause is a fracture of a portion of the lumbar vertebrae (the isthmus), which is referred to in medical terminology as a “vertebral arch breakdown” (Figure 1). The isthmus of the vertebral arch plays a very important role in maintaining the normal alignment of the lumbar spine, and once a fracture occurs, the lumbar spine will not be able to withstand the normal physiological load (referring to walking, sitting, and lying in normal life), and over time, slippage will occur. In adults, the main cause of lumbar spine slippage is mostly due to degeneration of the lumbar intervertebral disc and a series of related pathological and physiological changes. If lumbar spine slippage becomes increasingly severe, it can cause compression of the nerves. Major symptoms Many patients with lumbar spine arch collapse or lumbar spine slippage, especially in the early stages, may not have obvious symptoms. There may be diffuse pain in the lower back that is similar in nature to a sprain of a muscle. There can be spasm and stiffness in the lower back, as well as tension in the posterior lunate cord muscle of the lower extremity, causing changes in posture and gait. If the slippage worsens, it can cause nerve compression and narrowing of the spinal canal and cause symptoms such as radiating pain in the lower extremities and inability to walk continuously (intermittent claudication). Ancillary examinations X-ray radiographs. Ortho-, lateral- and left-right 45° oblique radiographs of the lower lumbar spine can be performed. Through radiographs, the degree of slippage can be assessed and the cause of lumbar slippage can be generally determined. On an oblique radiograph, the articular eminence and the isthmus of the vertebral arch form a wonderful puppy figure, and the isthmus of the vertebral arch in turn forms the neck of the puppy. In other words, if there is a “collar” in the neck of the puppy, then this is indicative of a collapsed arch (Figure 2). If the nerve is compressed by the slipped lumbar spine, CT and MRI should be performed to determine the extent and location of the nerve compression. Rational treatment Once a lumbar spondylolisthesis is clearly diagnosed, conservative treatment should be considered first. Athletes should stop training until the symptoms are reduced or disappear. Non-steroidal anti-inflammatory and analgesic drugs such as ibuprofen can be applied to relieve pain. Application of a lumbar spine brace can provide some supplement to the stability of the lumbar spine. Performing epidural hormone injections can reduce the local inflammatory response and thus serve the purpose of analgesia. Activities can be gradually restarted after symptoms have improved. Patients should perform exercises for the low back and abdominal muscles under medical supervision to enhance the stability of the lumbar spine and reduce the likelihood of stress fractures. Staged radiographs should be performed to determine if there is further aggravation of the slippage. If there is an aggravation of the slippage, or if the local symptoms do not improve significantly with conservative treatment, surgical treatment should be considered. Generally speaking, surgery for lumbar spondylolisthesis should include two main components. The first is to relieve the compression of the nerve; the second is to ensure the stability of the lumbar spine. The former is professionally known as decompression, which means that a portion of the bony structures, hyperplastic ligaments, scar tissue, etc. that are compressing the nerve should be removed, and if necessary, the herniated disc should be removed. This will release the nerve compression and also reduce the inflammatory response of the nerve. This relieves the symptoms. However, this operation can sometimes further weaken the stability of the lumbar spine, so fusion of the lumbar spine should be performed to enhance the stability of the lumbar spine. So, how is stabilization surgery of the lumbar spine performed? Usually, some healthy bones are taken from other parts of the body (such as the iliac bone) and transplanted to the local part of the lumbar spine, and when these transplanted bones heal, the upper and lower lumbar spine grow together, which is called fusion of the lumbar spine. In recent years, scholars at home and abroad have found that implantation of metal internal fixation in the lumbar spine can improve the efficacy of lumbar spondylolisthesis. After the implantation of the internal fixation, the lumbar spine can be immediately stabilized as necessary and the time spent in bed can be reduced. The implantation of an internal fixation device can increase the chance of lumbar fusion. Some reports suggest that the fusion rate without internal fixation is 60% to 70%, while the application of internal fixation devices increases the fusion rate to more than 90%. In patients with severe lumbar spondylolisthesis, repositioning of the spondylolisthesis is sometimes required to improve neurological symptoms and enhance the outcome of treatment. Metal internal fixation devices help to reposition and fix the slippage in most cases. Therefore, the advent of metal internal fixation devices has somewhat enriched the means of surgical treatment of lumbar spondylolisthesis and improved its efficacy. Of course, metal endoprostheses are also corresponding problems, such as increased cost of treatment, increased operative time and surgical trauma, and sometimes some complications associated with them, such as breakage and loosening of the endoprosthesis. Therefore, the surgical approach has a certain range of applicability and should be approached with caution.