How to correctly understand lumbar spondylolisthesis

  Lumbar spondylolisthesis is a common imaging phenomenon in orthopedic surgery, and the numbness and “intermittent claudication” caused solely by lumbar spondylolisthesis is called “lumbar spondylolisthesis” or “lumbar spinal stenosis “Lumbar spinal stenosis”. The main manifestation of the patient’s lumbar leg pain and numbness is the conscious numbness and pain in one or both lower limbs, which can be light on one side, light on one side, or alternately on both sides; the concept of “intermittent claudication” is that the patient must stop walking after walking a certain distance because the numbness and pain is aggravated, or even must squat for a certain period of time to wait for the numbness and pain to be alleviated before continuing to walk, but after walking a certain distance or time, the patient can continue to walk again. After walking a certain distance or time, the patient has to rest again because of the numbness and pain, and so on and so forth. In general, patients who walk less than 500 meters or 10 minutes continuously without pain and have increased numbness in the lower back and legs are defined as pathological and require treatment.  The disease is most often seen in middle-aged and elderly female patients. Clinically, the degree of slippage is generally classified into a total of 4 degrees according to X-rays, with I slippage being the mildest. On the other hand, lumbar spine slippage is also another manifestation of lumbar spine instability, mainly related to lumbar back muscle and ligament laxity, disc herniation and osteoporosis, etc. A few patients are due to trauma or unexplained lumbar fracture. Clinical treatment is divided into surgical and non-surgical, and the majority of patients can prefer non-surgical methods, which must be considered in light of the degree of lumbar spondylolisthesis, the severity of clinical symptoms and the length of the disease and its changes. If the lumbar spine is mildly slipped, generally the clinical symptoms are not serious, and non-operative treatment should be preferred according to the routine. In addition, since slippage is common in middle-aged and elderly women, and the causes of lumbar pain are diverse, a clear diagnosis must be made before deciding on specific treatment, i.e., to determine that the pain must be caused by the slipped lumbar spine, which must be determined by an experienced specialist. Besides, the cause of back pain in the elderly may be or be combined with “osteoporosis”, the main symptom of which is also back and leg pain. In short, a clear diagnosis is a prerequisite for treatment.  Mild lumbar spondylolisthesis alone is very common in orthopedic clinics, and since it is the slipped lumbar spine that causes the nerve or nerve root compression, not the spinal cord, that causes the numbness and inability to walk continuously, patients should not worry about future paralysis. Nevertheless, because of the inconvenience the disease can cause, patients must actively seek medical treatment. Most of the non-surgical treatments are effective, with the main effects being a reduction in numbness and pain in the affected limb, a longer continuous walking distance and a consequent improvement in the quality of life. In this sense, the main goal of all non-surgical treatment is to restore the patient to the stage of slipping without symptoms, rather than to “reset” the slipped lumbar spine. To be precise, non-surgical treatment is unlikely to reset a slipped lumbar spine, and if possible, it will slip again. Besides, the patient has no way of knowing when the lumbar spine slipped, and it is only discovered for the first time when a film or CT is taken, and it may have been with you for a long time without incident. The Department of Orthopaedic Injuries (Shih’s Injuries) at Shuguang Hospital specializes in the treatment of this disease using a variety of integrated therapies such as traditional Chinese medicine, acupuncture and moxibustion and manipulation, and the majority of the results are satisfactory. A small number of patients with severe lumbar spine slippage, progressive aggravation of numbness and pain, and ineffective non-surgical treatment for at least 6 months can consider surgical treatment, the main purpose of which is to try to reset and fix the slipped lumbar spine through surgical methods, so as to eliminate the symptoms.  In order to prevent recurrence and consolidate the effect of treatment, patients must also pay attention in their normal life and work. The principle is “do something but not something”. “Do something” mainly refers to some exercise methods to increase the muscle strength of the lumbar back, in order to enhance the stability of the already “unstable” lumbar spine. Patients can choose their own exercise program according to their personal preferences and conditions, and any method can be used, as long as it is “gradual and insistent”; “something not to do” refers to all that is harmful to the lumbar spine and its muscles should be avoided. For example, the lumbar spine weight, long-term sleep in a soft bed, sedentary and standing, poor posture, overweight, suffer wind and cold, etc..