What is lumbar spondylolisthesis? Lumbar spondylolisthesis is the partial or complete slippage of the upper vertebrae on the surface of the lower vertebrae due to abnormal intervertebral connections. Simply put, a lumbar slip is the forward or backward displacement of one vertebral body over another vertebral body. Lumbar spondylolisthesis is generally an anterior slip. Posterior slippage occurs in the lumbar 5 and lumbar 4 vertebrae, accounting for about 95%, with the incidence of 82-90% in the lumbar 5 vertebrae and rare in other lumbar vertebrae. Some traumatic or degenerative slippage can occur in multiple segments simultaneously, and even posterior slippage can occur. How is lumbar spondylolisthesis caused? Lumbar spondylolisthesis is mainly caused by abnormal bony connections between vertebrae. There are five main types of abnormal intervertebral bony joints. (1) Congenital dysplasia: due to a defect in the upper sacral or lumbar 5 vertebral arch, thus lacking sufficient strength to stop the tendency of the vertebral body to move forward and slip forward. It is hereditary, and cases of lumbar vertebral slippage in both parents and children have been reported. (2) Abnormalities of the isthmus of the articular eminence trigger slippage: abnormalities of the isthmus may include fatigue fractures of the isthmus, 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 they take on a special shape, the joint has become horizontal and gradually slipped. Most commonly seen after the age of 50, the incidence of women is three times higher than that of men. It is mostly seen in lumbar 4, followed by lumbar 5. (4) Traumatic: trauma causes fractures of the vertebral arch and isthmus of the small joints, and slippage occurs due to disruption of the continuity of the anterior and posterior structures of the vertebral body. (5) Pathological fracture: the loss of stability of the vertebral body due to localized lesions involving the upper and lower synapses of the vertebral isthmus, resulting in vertebral body slippage. 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 in 15%, and the most common is degenerative slippage. Precautions for lumbar spondylolisthesis If there are symptoms of nerve root compression, decompression of the nerve root canal and spinal canal is also required to eliminate pain and numbness in the lower extremities caused by lumbar spondylolisthesis, etc. Lumbar spondylolisthesis is caused by the loss of fixation and linkage of the joints connecting the lumbar spine for some reason. The causes include congenital arch rupture, degenerative lumbar spine joint disease, and even traumatic causes. However, congenital arch rupture and degenerative lumbar spine disease are the most common clinical causes, with trauma being the minority, as the trauma that would cause an arch rupture would most often be severe enough to cause a further fracture. Lumbar spondylolisthesis mostly occurs in the fourth and fifth lumbar vertebrae and the fifth and first lumbar vertebrae, because these two areas are the joints that bear the greatest burden during upper body movements. The early stage of lumbar spondylolisthesis is characterized by back pain, which is mainly due to the instability of the joint at the site of spondylolisthesis, causing excessive burden on the lumbar muscles. Such symptoms can be improved with proper rest and rehabilitation, but they can recur again and again. When the joint is repeatedly weighted under instability, the bone spur will grow, and when the bone spur grows to a certain level, it will cause nerve compression, resulting in walking discomfort, leg pain and weakness. Such a disease can be treated by internal medicine, rehabilitation or surgery. However, patients with severe symptoms will most likely require surgery. Since the main cause of the disease is the instability of the lumbar joint, it is necessary to solve the problem surgically by internal fixation with steel nails and autologous bone graft. However, such surgery must be performed under the experience of a specialized spine surgeon or neurosurgeon in order to avoid nerve damage, which no one wants to see. Clinical symptoms of lumbar spondylolisthesis Most lumbar spondylolisthesis is asymptomatic. Symptoms and signs in patients are related to the type of slippage, lumbar spine stability, degree of slippage, age, gender, and other factors. Generalized slippage is most often seen after the age of 50, and the incidence increases with age. Patients may have lumbosacral pain and soreness that may be dissipated to the back of the thigh or the whole thigh. When the lumbar spine is less stable, the pain is characterized as follows: pain and stiffness of the lower limbs are realized at rest and 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 may manifest as increased lumbar anterior convexity and pressure pain in the spinous process at the diseased vertebrae.