Lumbar spondylolisthesis is a partial or complete slippage of the superior and inferior vertebrae due to abnormal bony connection of the adjacent vertebrae caused by congenital dysplasia, trauma, strain and other reasons. It is completely different from lumbar disc herniation, which is a common disease and accounts for a large proportion of the daily work in our department, and is introduced here. (with a description of the various types of slippage cases done)
Shear forces exist in the spine at any motion segment, and they are particularly pronounced in the lumbosacral region because the vertebral space is tilted. Therefore, there is a tendency for the upper vertebral body to slip and rotate forward against the next vertebral body, so it is most commonly seen in the lumbar 5 sacral 1 interspace. Under physiological weight loading, the lumbar vertebrae maintain normal positional relationships with each other depending on the synovial joints, the fibrous rings of the intact discs, the surrounding ligaments, the contraction forces of the dorsal extensors, and normal spinal force lines. Weakening or loss of any one or more of the shear resistance mechanisms will lead to lumbosacral instability and, in time, to slippage. The slipped vertebrae may cause or aggravate spinal stenosis, irritate or squeeze the nerves, causing symptoms such as low back pain, lower extremity pain, lower extremity numbness, and even urinary and fecal dysfunction. In addition, the protective contraction of the lumbar back muscles after slipping can cause lumbar back strain and produce lumbar back pain.
The main symptoms include the following.
1, lumbosacral pain: mostly manifested as dull pain, and very few patients can have severe caudal pain. The pain can appear after exertion or persist after a sprain. The pain is aggravated when standing or bending, and reduced or disappeared after bed rest.
2, sciatic nerve involvement: manifested as radiating pain and numbness in the lower extremities, which is due to the fibrous connective tissue or hyperplastic bone scabs at the isthmus break can compress the nerve root, and the nerve root is strained when slipping; straight leg raise test is mostly positive.
3, intermittent claudication: if the nerve is compressed or combined with lumbar spinal stenosis, intermittent claudication symptoms often appear.
4, the cauda equina nerve is pulled or compressed symptoms: when the slippage is serious, the cauda equina nerve is involved and symptoms such as lower limb weakness, saddle area numbness and urinary and fecal dysfunction can occur.
5. Increased lumbar anterior convexity and hip lordosis. Patients with more severe slippage may experience lumbar depression, abdominal protrusion, and even trunk shortening and swaying when walking.
6.Palpation The upper spinous process of the slipped spine is moved forward, and there is a feeling of step at the back of the waist and pressure pain in the spinous process.
Lumbar spondylolisthesis is also often combined with other degenerative diseases of the lumbar spine, mainly including the following.
1, lumbar disc herniation
2.Lumbar spinal stenosis
3.degenerative lumbar scoliosis
Indications for surgery include one of the following.
1.Lumbar spondylolisthesis of degree II or less, with intractable low back pain, or aggravation of the original lower back pain symptoms, which is ineffective through regular conservative treatment and seriously affects the patient’s life and work;
2.Companied by lumbar disc herniation or lumbar spinal stenosis, radicular radiating pain and intermittent claudication of the lower limbs, or symptoms of cauda equina compression;
3.Long duration of the disease, with a tendency of gradual aggravation;
4.Severe lumbar spondylolisthesis of degree III or above.
Surgical methods.
1, neurological decompression The main purpose is to fully allow nerve root decompression, which can be done by unilateral or bilateral laminectomy, or if laminectomy is unavoidable, additional spinal fusion must be performed. In contrast, if the symptoms of lumbar spondylolisthesis are caused by lumbar instability without spinal stenosis, only lumbar fusion fixation is required without spinal decompression.
2.Spinal fusion Long-term stability depends on a strong biological fusion. There are many methods of spinal fusion, which can be divided into: intervertebral fusion, posterior-lateral fusion, periradicular 360° fusion, etc. according to the site of bone grafting; we currently focus on the mainstream surgery (posterior minimally invasive TLIF surgery), i.e. minimally invasive intervertebral fusion surgery via unilateral intervertebral foramen. Minimally invasive surgery is not measured by the size of the wound, which is often misleading in terms of putting the cart before the horse! Minimally invasive is the surgery on the body’s original structure damage damage tiny, it is the method and concept skills.
3.Lumbar spondylolisthesis repositioning The current mainstream view is to try to reposition if possible, because the normal anatomical position of the lumbar spine and nerve roots can be reconstructed. We have advanced reset surgical instruments and mature process technology, most of them can be satisfactorily and safely reset.
4.Internal fixation of the spine mainly includes strong fusion internal fixation, methods such as pedicle screw fixation. There is also the isthmus bone graft repair for young early patients. The success rate of our pedicle screw placement is over 95%, especially the most difficult sacral nail, because of our unique technical method, we can make the nail placement easy, safe, fast and minimally invasive, without major stripping, and we can usually use a screw of 40mm length or more and fix it at the strongest sacral cape, instead of the 30-35mm length non-sacral cape fixation screw used by most doctors, to ensure The prerequisites for successful repositioning and fusion.
Postoperative guidance
Patients treated with fusion internal fixation surgery can get up and move around wearing a lumbar brace three to seven days after surgery, but should avoid premature strenuous physical work, and can usually drive six weeks after surgery, and can do light physical activities such as cycling and laundry after three months, but avoid heavy physical activities such as carrying burdens and objects. Patients should continue to adhere to the functional exercise of the lumbar and back muscles, and increase the intensity of the exercise based on their physical strength, and be persistent. Outpatient follow-up to check the fusion of implants and internal fixation.
It is extremely important to quit smoking, and you can drink some red wine.