Spondylolisthesis - Spondylolysis

It is the slipping of a spinal bone over the adjacent spine. The displacement of the spine narrows the spinal canal and compression of the nerve occurs. Its medical nomenclature is "spondylolysis or spondylolisthesis". It is a disease known as "slipped waist" among the people.

It can occur in young people with a congenital lack of development in the joints and bones connecting the spine. Over the age of 40, it may occur as a result of trauma or fractures due to bone resorption.

It is most common in the region of the lumbar vertebrae.

The types of spondylolisthesis can be listed as follows:

• Dysplastic (congenital) type: It is usually seen at the lowest level. It occurs at a young age.

• Istmic type: (due to a fracture in the isthmus) is common in middle age.

• Degenerative type: There is a forward shift in the facet joints due to degeneration and enlargement. The degree of slippage is not very clear. It is seen in women between the ages of 50-60 and most frequently at the L4-5 level.

• Traumatic type: It occurs when the pedicles break as a result of severe trauma.

• Pathological type: It is seen in diseases such as tumor, Paget, osteogenesis imperfecta, achondroplasia, rheumatoid arthritis.

Lumbar Spondylolysthesis Symptoms

Usually it may not be asymptomatic. Therefore, it can be diagnosed incidentally. Symptoms of waist shift can be listed as follows:

• Severe, burning pain in the waist (Pain increases when standing, walking, exercising and bending backwards.)

• Numbness, pain, muscle tension, weakness in the legs

• Increased waist slope or trouble walking

• If it is associated with a narrow canal, cramping occurs in the legs and hips along with weakness during long walks.

Lumbar Spondylolisthesis Diagnosis

X-ray: It can be easily diagnosed with two-sided plain radiographs taken while standing up. An evaluation can be made according to the degree of slippage. If there is a slip less than 25%, it is considered as 1st degree, 25-50% as 2nd degree, 50-75% as 3rd degree or more.

Computed Tomography : A fracture in the posterior elements of the spine can be missed on direct radiographic images. It gives information about the condition of the spinal canal and the bones. Fractures and deficiencies in the joint can be seen.

Magnetic Resonance Imaging: It is used in the evaluation of disc pathologies and ligamentous lesions, neurological elements. It is important in the diagnosis of narrow channel.

Lumbar Spondylolisthesis Treatment

Conservative Treatment

Initially administered painkillers, cold and hot therapies, epidural steroid injections , physical therapy (With treatment protocols applied in physical therapy; pain reduction, significant increase in range of motion and function in the lumbar region, stabilization in the spine are provided. Increasing cycling exercises should be preferred more than walking), flexion stretching exercises and isometric waist stretching exercises are recommended in patients with a conservative treatment protocol. Pain complaints usually disappear with these treatments. If the pain persists for 3 months or the development of "loss of strength" is the most important indicator that the patient is a candidate for surgery.

Lumbar Spondylolisthesis Surgery

Surgery is required in patients with slipped back who fail conservative treatment. In the operation; nerve decompression, stabilization with spinal fusion is applied. Spinal bones are fixed using titanium screws, rods and special cages for interbody fusion. The aim of fusion surgery is to prevent instability and to reduce the pain associated with degenerative disc-facet joints. With the use of these implants, the physiological spine alignment is restored and indirect decompression occurs with the opening of the neural foramina.

After Spondylolisthesis Surgery

When you can return to work after surgery varies depending on the job you are doing. If you have a desk job, you can return to work in as little as 2-3 weeks after surgery. If your job is based on body strength, you may need to wait up to 2 months for the bones to heal and boil. A full post-operative rehabilitation program is recommended for you to return to daily life.

Dr. Tamer Tekin