Back pain from slipping rings - Spondylolisthesis

Treatment of degenerative spondylolisthesis - a dilemma that requires methodical and correct choices

Dr. Nexhmedin Duriqi
Orthopedic spine
tel. + 38344 233485
email: dr.duriqi@gmail.com, nex68@yahoo.com

Spondylolisthesis is defined as anterior or posterior slippage of the annulus relative to the other below it, with or without spinal instability.

It presents a bony protuberance that makes childbirth difficult.

The defect in spondylolisthesis lies in the interarticular part of the rings. Spondylolysis (spondyloschisis) defines the defect of one or both sides of one or both articulating parts of the ring, with or without slipping of the rings.

Etiology - causes

The causes are multiple:

– Innate predisposition
– Posture (stance), pregnancy, rotative forces, high stress loading – role in sliding

Defect in the lower back, its upper part or conditions associated with spina bifida occulta and radiculopathy. Interarticular defect, usually L5.

At young ages

Mainly degenerative diseases, disc degeneration or segmental instability most often at L4/L5

Advanced ages

Mainly traumatic = fracture of any part of the neural arch resulting in listhesis.

Then, pathological = generalized bone disease like Mb. Pay or osteogenesis imperfecta.

Sharing

Depending on the degree of slippage of the rings in the sagittal plane, according to Meyerding (1932):

Grade 1 – ≤ 25% of the vertebral diameter
Grade 2 – 25-50%
Grade 3 – 50-75%
Grade 4 – 75-100%
Spondyloptosis – over 100%

Clinical signs

They vary, depending on type and age.

Back pain, at the beginning of the mild degree, extending to the thighs, especially after activities; pain on palpation (pressure); limitation of back movement; difficulty walking accompanied by pain.

Clinically, the shortening of the muscles of the thighs and gluteus (buttocks), the impossibility of flexion (gathering) of the hamstrings with extended knees, an increase in the waist arch from the inside, and a gradual transition from the normally arranged rings to the one with slides.

Troubleshooting

Standard x-ray in two directions, x-ray in dynamics - forward or backward and side bending.

Ct and MRI in special cases when we suspect that we are also dealing with compression of the nerve roots (radicular)

Treatment:

∙ Operative treatment – ​​not always.
∙ Reduction of activities that tend to increase ring slippage; when sitting, back support is preferred. Rehabilitation and strengthening of the anterior abdominal and posterior back muscles and other conservative measures.
∙ Application of the antilordotic corset
∙ Flexible - positive, extensive - negative exercises
∙ Surgical intervention, with the exception of patients with radiculopathy and smokers.

Read too Degenerative disc disease

Risk factors should also be taken into account Young age (<15 years) High-grade slip (>30%)

At young ages, the highest success rate of the intervention is the shortening of the hamstrings.

Whereas, as an indication for fusion, pain during walking or strenuous movements is the progression of the slip - from the first degree to the second or more.

∙ Postoperative treatment Postoperative orthosis – surgeon's preference.
∙ Mobilization after 24 hours.
∙ Adequate analgesia essential for breathing and early uprighting.
∙ Steroids do NOT – interfere with fusion. (Traction nerve injury – steroids 3-5 days).
∙ Expect pain of moderate intensity for several weeks.
∙ Physical activities after 3 months.

∙ However, the biggest challenge remains choosing the optimal patient.

/Telegraph/