We know that normally, the lumbar spine is straight from the front, while from the side, the lumbar spine presents a forward harmonious curvature. There are five lumbar vertebrae, which are neatly arranged and aligned with each other. In some cases, there is a “misalignment” between the lumbar vertebrae (this misalignment is often the upper lumbar vertebrae slipping forward), and we call this movement and misalignment between the lumbar vertebrae “lumbar spondylolisthesis”.
There are many causes of lumbar spondylolisthesis. In adolescents, the most common clinical cause is a fracture of a part of the lumbar vertebrae (the isthmus of the vertebral arch), which is referred to in medical terminology as an “arch fracture”. The arch isthmus plays a very important role in maintaining the alignment of the lumbar vertebrae with each other, and once it is broken, the lumbar vertebrae will not be able to withstand the normal physiological load, and over time, they will slip.
In adults, the main cause of lumbar spine slippage is mostly due to degeneration of the lumbar intervertebral disc and a series of related pathophysiological changes. If lumbar spine slippage becomes more and more severe, it may cause nerve compression and require surgery if necessary.
So, what are the causes of lumbar spondylolisthesis?
Genetic factors Vertebral arch collapse may have a certain genetic predisposition. Some patients are born with fragile vertebral arch isthmus and thus are particularly prone to rupture, which, together with accelerated growth and development during adolescence, contributes to the occurrence of lumbar spondylolisthesis.
Certain sports, such as gymnastics, weightlifting and soccer, cause regular repetitive stress on the lumbar arch isthmus; in addition, the continuous hyperextension of the lumbar spine during exercise is also an undesirable stress, and the combination of these factors can eventually cause a fracture of the arch isthmus on one and both sides.
Degeneration Degenerative changes in the lumbar spine can cause narrowing of the space between the lumbar vertebrae, instability and hyperactivity of the intervertebral joints, and greatly increased stress on the isthmus of the vertebral arches.
Other factors, such as cerebral palsy, are also possible causes of lumbar spondylolisthesis.
And what are the symptoms of lumbar spondylolisthesis?
DD Many patients with lumbar arch collapse or lumbar spondylolisthesis, especially in the early stages, may not have obvious symptoms.
DD may have diffuse pain in the lower back that is similar in nature to a muscle sprain.
DD can present with spasm and stiffness in the lower back and tension in the N cord muscle at the back 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).
What tests can be done if I suspect that I have a lumbar spondylolisthesis?
X-ray radiographs. Orthopantomogram, lateral radiograph and 45o oblique radiograph of the lower lumbar spine can be performed. The extent of the slippage can be assessed and the cause of the lumbar slippage can be generally determined. On oblique radiographs, the articular eminence and the arch isthmus form a wonderful puppy figure, which 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.
If the nerve is compressed after a lumbar spondylolisthesis, CT and MRI should be performed to determine the extent and location of the nerve compression.
How should lumbar spondylolisthesis be treated?
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 improve. Patients should perform low back and abdominal exercises 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 any 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 elements. 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 a fusion of the lumbar spine should be performed to enhance the stability of the lumbar spine.
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, domestic and foreign scholars have found that the implantation of metal internal fixation in the lumbar spine can improve the efficacy of lumbar spondylolisthesis. This is because: firstly, the implantation of internal fixation can make the lumbar spine get the necessary stability immediately and reduce the time of bed rest; secondly, the implantation of internal fixation device can increase the chance of lumbar spine fusion, and it has been reported that the fusion rate is 60-70% when no internal fixation is used, but the fusion rate increases to more than 90% after the application of internal fixation device;
Finally, in patients with severe lumbar spondylolisthesis, repositioning of the spondylolisthesis is sometimes necessary 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 have 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 indications for surgery should be strictly controlled.