Spondylolisthesis: symptoms, grades, treatments, operation, sport

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 Lumbar spondylolisthesis is the sliding of a lumbar vertebra relative to the vertebra just below and carrying with it the rest of the spine. Three types of spondylolisthesis correspond to three different causes: the repetition of mechanical stresses on the spine, osteoarthritis of the joints, or a congenital malformation. Surgical operation is recommended only in case of failure of medical treatment or the presence of motor or sphincter neurological disorders.

Spondylolisthesis symptoms, grades, treatments, operation, sport


What is a spondylolisthesis?

Definition of spondylolisthesis

Lumbar spondylolisthesis corresponds to the sliding of a lumbar vertebra forward and down relative to the vertebra just below and carrying with it the rest of the spine. Spondylolisthesis has four stages of increasing severity with, at the extreme, the fall of the vertebra into the small pelvis.

Types of spondylolisthesis

There are three types of spondylolisthesis:


  • Lumbar spondylolisthesis by isthmic lysis affects 4 to 8% of the population. It is secondary to the fracture of the isthmus, the bony bridge connecting one vertebra to the other. The fifth and last lumbar vertebra (L5) is most often affected. The disc between the two vertebrae crashes and decreases in height: this is called associated disc disease;
  • Degenerative lumbar spondylolisthesis or osteoarthritis spondylolisthesis is secondary to the appearance of osteoarthritis of the joints. The fourth and fifth lumbar vertebrae are usually affected, but the slippage is generally not very important. The disc between the two vertebrae wears out and crashes and decreases in height, this is called associated disc disease;
  • Dysplastic lumbar spondylolisthesis, which is rarer, is of congenital origin.

Causes of spondylolisthesis



Contrary to popular belief, lumbar spondylolisthesis by isthmic, lysis is not due to a single trauma in childhood or adolescence, but to the repetition of mechanical stresses on the spine, which lead to a "fatigue fracture" of the isthmus (a bone bridge between two vertebrae).


Degenerative lumbar spondylolisthesis or osteoarthritis spondylolisthesis is, as the name suggests, related to osteoarthritis of the joints.


Dysplastic lumbar spondylolisthesis is secondary to a malformation of the last lumbar vertebra whose isthmus is abnormally elongated


Diagnosis of spondylolisthesis

Radiography of the lumbar spine allows the diagnosis of the type of spondylolisthesis and the evaluation of its severity according to the slippage of the vertebra.

The radiological assessment is completed by:


  • A CT scan of the lumbar spine to visualize the fracture of the isthmus;
  • Magnetic resonance imaging (MRI) of the lumbar spine allows, if necessary, better visualization of the compressed nerve root, an analysis of the compression of the dural cul de sac or ponytail (lower part of the dura mater containing the motor and sensory nerve roots of the two lower limbs and the bladder and rectal sphincters) and an analysis of the state of the intervertebral disc between the two vertebrae;
  • Electromyography is used to assess the health of the muscles and nerve cells that control them. It is performed only if the patient does not have all the characteristic symptoms of spondylolisthesis or if the symptoms are mild.

Persons affected by spondylolisthesis

Lumbar spondylolisthesis by isthmic lysis affects 4 to 8% of the population. It is frequently observed in high-level athletes practicing activities requiring rotations of the spine and frequent arched postures.


Dysplastic lumbar spondylolisthesis most often involves adolescents and young adults.

Factors promoting spondylolisthesis

Lumbar spondylolisthesis by isthmic lysis is promoted by the following factors:

Regular sports activities with spine rotations and frequent arched postures such as rhythmic gymnastics, dance, throwing sports, rowing, or horseback riding;
Work positions requiring forward-leaning postures;
Regular carrying of heavy loads or a heavy backpack in the child.
Degenerative lumbar spondylolisthesis can be promoted by:

  • Menopause;
  • Osteoporosis.

Symptoms of spondylolisthesis

Pain

Long well tolerated, spondylolisthesis is often discovered by chance on an X-ray assessment of the pelvis or in adulthood during the first low back pain.

Low back pain

Lower back pain, relieved by a forward-leaning position and aggravated by a leaning back position, is one of the symptoms of spondylolisthesis. The intensity of this low back pain varies from the sensation of a gene in the lower back to the acute pain of sudden onset – often following the carrying of a heavy load – called lumbago.

Sciatica and cruralgia

Spondylolisthesis can lead to compression of a nerve root where the nerve exits the spine and cause pain in one or both legs. Sciatica and neuralgia are the two representatives.

Cauda equina syndrome

Spondylolisthesis may result in compression and/or irreversible damage to nerve roots in the dural cul de sac. This cauda equina syndrome can cause sphincter disorders, impotence, or prolonged and unusual constipation...


Partial or complete paralysis

Spondylolisthesis can be responsible for partial paralysis – feeling of letting go of the knee, inability to walk on the tip or heel of the foot, impression of a foot scraping the ground when walking... The pressure exerted on the nerve root can lead to irreversible damage with the ultimate consequence of complete paralysis.

Other symptoms

Neurogenic claudication or the obligation to stop after a certain distance traveled; Paresthesias, or disorders of the sense of touches, such as numbness or tingling.


Treatments for spondylolisthesis

Medical treatment is recommended when spondylolisthesis is painful but no neurological signs are diagnosed. This treatment varies according to the pain:

  • Analgesics in the background treatment of low back pain associated with nonsteroidal anti-inflammatory drugs (NSAIDs) for 5 to 7 days in case of attack;
  • Rehabilitation includes exercises to strengthen the abdominal and lumbar muscles;
  • In case of a recent fracture of the isthmus or intense low back pain, immobilization with a Bermuda cast integrating a thigh on one side may be advised to relieve pain.
In case of failure of medical treatment or the presence of motor or sphincter neurological disorders, surgery for spondylolisthesis may be required. It consists in performing an arthrodesis or definitive fusion of the two painful vertebrae. Arthrodesis can be associated with a laminectomy: this operation consists of releasing the compressed nerves. This procedure can be performed minimally invasive using two small lateral incisions, with the advantage of significantly reducing postoperative low back pain.

Preventing spondylolisthesis

Some precautions should be taken to avoid the appearance or aggravation of spondylolisthesis:

  • Request a job adaptation in case of jobs with strong constraints: repeated forward-leaning position, carrying heavy loads...
  • Avoid sports activities in hyperextension;
  • Do not carry heavy backpacks on a daily basis;
  • Do not suppress the practice of leisure, sports which, on the contrary, allows to strengthen the lumbar and abdominal musculature. ;
  • Conduct radiographic monitoring every five years.

Who to consult?

'A rheumatologist or surgeon. How to choose? When we are faced with a small, non-progressive shift that is not very painful, we can quite see a rheumatologist. On the other hand, if the disc continues to evolve and it hurts more and more, it will be necessary to stabilize the slippage by surgery, "notes the specialist.

What are the treatments?

Treatment is prescribed depending on the pain felt by the subject. In addition to an analgesic or an anti-inflammatory to take in case of pain, physiotherapy sessions are prescribed in order to obtain back-pain muscle strengthening but also abdominals. The patient can be put to rest for a few days with temporary wear of a corset, but he must resume normal activity without waiting while avoiding the practice of certain sports (with impact or contact for example). Surgical intervention is decided only in case of serious damage to the vertebral disc or when the evolutionary risk is considered serious and will allow fixing the displaced area.
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