Lumbar spondylolisthesis is primarily caused by abnormal intervertebral bony connections. There are five main conditions of abnormal intervertebral bony connections.
(1) Congenital dysplasia: due to defective upper sacral or lumbar 5 vertebral arches, thus lacking sufficient strength to stop the tendency of the vertebral body to slip forward. It is hereditary, and cases of lumbar vertebral body slippage in both parents and children have been reported.
(2) Abnormalities of the isthmus of the articular process trigger slippage: isthmus abnormalities can include isthmus fatigue fractures, acute fractures of the isthmus; and lengthening of the isthmus.
(3) Degenerative changes: wear and tear of the corresponding small joints due to prolonged lumbar instability or increased stress. Degenerative changes, so that it presents a special form, joint abruptly changed to the level and gradually slipped. Most commonly seen after the age of 50, the incidence of women is three times higher than that of men. Mostly seen in lumbar 4, followed by lumbar 5.
(4) Traumatic: trauma causes fracture of the vertebral arch, small joint isthmus, etc., and slippage occurs due to disruption of the continuity of the anterior and posterior structures of the vertebral body.
(5) Pathological fracture: due to localized lesions involving the upper and lower articular processes of the vertebral isthmus, vertebral body stability is lost and vertebral body slippage occurs.
In short, in addition to congenital slippage, most scholars now believe that lumbar slippage is mainly caused by trauma and strain. Congenital slippage accounts for 33%, isthmic cleft triggers slippage accounts for 15%, and the most common is degenerative slippage.
Clinical symptoms of lumbar spondylolisthesis
Most lumbar spondylolisthesis is asymptomatic. The symptoms and signs of patients are related to the type of slippage, the stability of the lumbar spine, the degree of slippage, age, gender and other factors. Generalized slippage is most often seen to develop after the age of 50, and the incidence increases with age. Patients may have pain in the lumbosacral region, and the soreness and swelling may be dissipated to the back of the thigh or the whole thigh. When the lumbar spine is less stable, the pain has the following characteristics: pain and stiffness of the lower limbs are realized at rest, which can be slightly relieved after activity, and the pain increases after prolonged standing and squatting activities, and is relieved after rest again. In case of spinal stenosis, there may be pain in the lower limbs, various motor sensory disorders, muscle stiffness, skin tingling, numbness, etc. Sometimes intermittent claudication occurs. When accompanied by disc herniation, the nerve traction sign is positive. The isthmus collapsing slippage is mostly seen under 50 years old may have low back pain and lower extremity pain, which may be aggravated or induced by lumbar hyperextension. Radicular pain may be present in combination with disc herniation.
Signs can be manifested as increased anterior lumbar convexity and pressure pain in the spinous process at the diseased vertebrae.
X-ray manifestations of lumbar spondylolisthesis
X-ray is very important for the diagnosis of lumbar spondylolisthesis and the formulation of treatment plan. The use of lateral, right and left oblique and power radiographs is necessary. Lateral radiographs can show the degree of slippage, oblique radiographs clearly show the isthmus lesion, and power radiographs, i.e., lumbar hyperextension and flexion radiographs, can determine the degree of lumbar instability.
Tomography and CT have a high diagnostic rate for isthmus lesions, and CT can clarify the presence of spinal stenosis and complications of disc herniation, and spinal canal imaging and nuclear magnetic examination can be used as needed.
Diagnosis of lumbar spondylolisthesis
(1) Long-term recurrent lower back pain, pain aggravated when standing or bending, alleviated by bed rest, sciatica in some patients, a few severe cases with lower limb muscle weakness, muscle atrophy, hyperalgesia, diaphoresis, etc.
(2) Restriction of lumbar posterior extension activities, anterior enlargement of the lumbar spine, and pressure pain of the spinous process of the affected spine.
(3) According to the above symptoms and signs, if the disease is suspected, lateral and oblique X-ray films of the lumbar spine can be taken to clarify the diagnosis, and in some cases, CT and nuclear magnetic examinations are required to clarify whether the spinal stenosis and disc herniation and other complications are combined.
Treatment of lumbar spondylolisthesis
(1)Non-surgical treatment: including bed rest, avoid participating in activities such as lumbar weight-bearing, twisting and bending, lumbar physiotherapy, lumbar brace, waist protection, strengthening lumbar back muscle exercise, local closure, and taking related drugs.
(2) Surgical treatment: For those who are ineffective in conservative treatment, severe slippage, radiographically confirmed slippage progression and accompanied by persistent nerve root compression and spinal stenosis, surgical treatment is available.
There are two types of surgery: one is to reposition and fix the slipped vertebral body with specific instruments through the posterior approach, while performing spinal cord and nerve root decompression and intertransverse process bone graft fusion. The second is an anterior discectomy with intervertebral body fusion.
Prevention of lumbar spondylolisthesis
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 in an abducted position, head up, chest up, upper limbs out of bed, while the lower limbs are also straightened and lifted backwards in a “swallow” position. The second is supine position, the two knees flexed, both feet on the bed, inhalation chest and waist, so that the hips away.