Spondylolisthesis (spinal listhesis, vertebral listhesis) is a displacement (slipping) of one of the vertebrae relative to the underlying one forward (anterolisthesis) or backward (retrolisthesis). Spondylolisthesis most often occurs in the cervical and lumbar spine, which have greater mobility and experience the greatest vertical load than the thoracic spine. Depending on the displacement of the vertebral bodies relative to each other, five degrees of spondylolisthesis are distinguished:
- I degree - displacement of the body of the overlying vertebra up to 25% relative to the underlying vertebra;
- II degree - displacement up to 50%;
- III degree – displacement up to 75%;
- IV degree – up to 100%;
- V degree (spondyloptosis) - complete displacement of the body of the overlying vertebra in relation to the underlying one.
There is also a distinction between stable and unstable spondylolisthesis. With stable spondylolisthesis, the posture adopted by a person does not affect the displacement of the vertebrae, but when the vertebral bodies are displaced depending on the position of the person’s body, we can talk about unstable spondylolisthesis.
Cervical spondylolisthesis - the overall picture
In most cases, the pathology forms in the area of the fourth or fifth spine . The main cause of the disorder is spondylolysis, which refers to the splitting of the vertebral pedicle. The pedicle is the section that attaches the body of each vertebra to the facet joints.
Taking into account the severity of the patient’s condition, doctors identify four stages of the disorder, which are always accompanied by neurological pathologies.
| Stage | Manifestation |
| 1 |
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| 2 |
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| 3 |
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| 4 |
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Grade 5 spondylolisthesis is characterized by complete prolapse of the vertebra
Attention! Spondylolisthesis of the cervical spine in most cases is provoked by injuries, which, if insufficiently cured or with large-scale damage, gradually lead to complications in the form of spondylolysis. Its spread may take several years until the condition becomes apparent.
Causes of the disease
Pathology develops due to many factors, but if they can be excluded, the disease can be prevented.
Basically, spondylolisthesis of the lumbosacral region occurs for the following reasons::
- Lack of physical activity. The vertebrae begin to settle, which causes their deformation. The slightest awkward movement can dislodge the discs.
- Poor food.
- Excessive loads.
- Bad habits.
- Passion for extreme sports.
These factors significantly worsen health:
- Dystrophic and degenerative disorders occur . Osteochondrosis, scoliosis develop, and hernias form. These diseases destroy the cartilage and bone tissue of the discs, leading to spondylolistosis.
- Malignant neoplasms develop . Tumors pinch nerve endings and discs are squeezed out. The progression of oncology causes the development of metastases that form in the vertebrae.
- The muscle corset loses elasticity . The normal alignment of the spine is disrupted, causing prolapsed discs. The slightest disruption of muscle tone relaxes or spasms muscle fibers, which leads to displacement of the vertebrae.
The diagnosis is confirmed by laboratory tests, the results of which reveal the cause, stage and location of the pathology.
Risk factors and causes of pathology development
Doctors often examine patients with cervical spondylolisthesis, which began in childhood due to a fracture. Primary signs of this condition of spinal displacement appear only after adulthood , and sometimes after the age of 35-45 years. Usually the triggering factor is a sudden or systematic load on the shoulder girdle; loaders often suffer.
The process of spreading the arches of the spine in the cervical region occurs very slowly, sometimes over decades. It is this possibility that in some cases does not allow us to immediately identify the process of the disorder and carry out quick and conservative treatment.
In addition, the disease can be caused by dislocations, sudden movements of the head back , small children are especially susceptible, unsuccessful surgical intervention, which violates the correctness and integrity of the support of the discs. Sometimes spondylolisthesis starts in utero or is acquired during childbirth, when the umbilical cord fails to wrap around the baby’s neck.
Attention! Sometimes the disease is transmitted through hereditary lines. However, it is difficult to say exactly how long it will take for spondylolisthesis to manifest itself. If there have been cases of such a violation in the family, more attention should be paid to preventive measures.
Stages of development
The degenerative process begins with the nucleus pulposus, which is normally represented by a gelatinous mass with high viscosity and elasticity. Constant metabolism is ensured by chondrocytes: the structures synthesize and break down proteoglycans for the matrix of the nucleus pulposus, which retains water and collagen in the annulus fibrosus. A healthy intervertebral disc maintains a certain level of pressure.
Abnormal mechanical axial stress due to the combined effects of unfavorable heredity, age, inadequate transport of metabolites and trauma worsens the condition of chondrocytes and triggers degeneration of the nucleus pulposus. This structure loses moisture. Dehydration leads to a decrease in intradiscal pressure with the transfer of mechanical load to the fibrous ring, in which microcracks appear, progressing to rupture. Through the gap, as the load on the spinal column increases, part of the intervertebral disc prolapses; during extrusion, a fragment larger than the base falls out.
Consequences of the development of cervical spondylolisthesis
The consequences of the violation are quite varied and depend on which vertebra is displaced and how visible this displacement is.
Most often, patients encounter such problems:
Spondylolisthesis can lead to pinching of the nerve and vertebral artery; a noticeable decrease in the length of the cervical spine;- pinched nerve and disruption of the bone marrow and brain;
- development of arterial hypertension;
- narrowing of the spinal tubules;
- disruption of the functioning of the organs of hearing and vision, sometimes in the absence of treatment, complete dysfunction of these systems occurs;
- the ear-nose-throat apparatus is often affected;
- the processes of memory and assimilation of information are disrupted, anesthesia may develop;
- Partial paralysis of the upper or lower extremities may develop.
Symptoms and methods of diagnosing the disease
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The symptoms of the disease are for the most part similar to the consequences caused by spondylolisthesis . In addition to problems with blood pressure, dysfunction of the musculoskeletal system, visual and auditory systems, the patient faces severe pain and the inability to perform even minor physical work.
Often with spondylolisthesis there is a strong burning sensation , a feeling of heaviness and discomfort in the cervical spine.
Diagnosis of the disease occurs during an in-person examination and the appointment of radiography. During the second procedure, the specialist assesses how far the vertebral pedicles have moved apart and whether there is any pathological displacement. For a more accurate diagnosis, an examination using MRI, CT and radiography with a functional test will be prescribed.
Attention! If the patient has disorders such as osteochondrosis, osteoporosis, kyphosis, scoliosis and other dangerous processes in the spine, you should pay close attention to the cervical spine. Sometimes the patient may mistake the resulting discomfort and pain for these chronic pathologies, allowing spondylolisthesis to further affect the system.
Video: “Displacement of a vertebra in the cervical spine: what to do?”
Surgery
Severe cases may require surgery. The method consists in immovably connecting two adjacent vertebrae using special plates and removing the deformed parts of the vertebra. On the one hand, this allows you to fix the spine, on the other hand, it limits its mobility. In addition, with pathological weakness of the musculoskeletal system, the “prolapsed” vertebra can now pull the healthy one along with it.
Regardless of the stage at which spondylolisthesis is diagnosed, the spine now requires rehabilitation measures at least twice a year (or even more often).
Treatment of cervical spondylolisthesis
Drugs
When the spine is displaced, NSAIDs and painkillers are taken. When spondylolisthesis develops, the patient is prescribed painkillers and anti-inflammatory substances .
Usually, preference is given to non-steroidal medications, as they cause minimal side effects and are well tolerated by patients.
Usually medications such as Nimesulide, Diclofenac, Nise, Nimica, Aponil are prescribed.
These medications can be used in the form of tablets, injections and powder. The attending physician decides which form to use for a particular patient. They are usually used within 5-10 days.
Painkillers can also be used in the form of tablets and injections.
The most common of them are Ketanov, Nurofen, Mig, Ibuprofen and others. Painkillers are rarely used for more than five days.
Surgery
Surgery is usually prescribed only for congenital spondylolisthesis . Surgical treatment is also prescribed for serious injuries and falls from a height. To begin with, the surgeon will fix the cervical vertebrae and insert plates and pins to keep them in the desired position. If there were no complications after the operation, rehabilitation lasts six months.
Exercises, exercise therapy and massage
This type of therapy is the main way to cure spondylolisthesis and restore lost health . The exercise therapy complex is selected separately for each patient, since it is important to take into account other chronic diseases not only of the musculoskeletal system, but also of other systems.
Massage helps relieve excessive tension and pain. It should be performed with as gentle movements as possible, without putting pressure on the damaged area. Usually 10 sessions are prescribed every 3-5 months, taking into account the severity of the condition.
Exercises are especially useful for spondylolisthesis.
- To begin with, you need to sit up straight and turn your neck left and right. 10 turns are made in each direction.
- After the turns, bend forward and backward, also 10 times in each direction. This way you can relieve the spasm.
- Pressing the forehead onto the arms crossed in front.
- Raise your shoulders up, holding them in this position for 10 seconds. The manipulation is required to be repeated 5 times.
Treatment of spondylolisthesis at home is impossible, as it necessarily requires medical prescriptions and diagnostics . At home, the patient can only perform the exercises prescribed to him and avoid putting stress on the cervical spine.
Prevention of cervical spondylolisthesis
To prevent even minimal displacement of the spine, a number of mandatory recommendations must be followed.:
Pay attention to the recommendations on how to avoid the development of spondylolisthesis; do not put heavy loads on the spine;- Strength training is especially dangerous during which the technique of performing the exercise is impaired;
- frequent sitting at a table, during which posture is not maintained;
- be sure to monitor your posture while walking and standing;
- be sure to take breaks if necessary to perform sedentary work or activities associated with constant stress on the musculoskeletal system;
- try to carry less heavy things, this rule especially applies to children and women;
- Injury to the spine and neck should not be allowed;
- if there are problems with the musculoskeletal system, it is necessary to prevent the exacerbation of these pathologies;
- systematically perform exercises to strengthen the muscles of the neck and back.
Attention! Sport is a prerequisite for the prevention of spondylolisthesis. But it is important to ensure the accuracy of the technique, the absence of overload and excessive fatigue, which can cause injuries and inflammation, which will subsequently lead to displacement of the cervical vertebral discs.
Conservative treatment
The main measures for the conservative treatment of listhesis are aimed at:
- pain relief with painkillers of various effects,
- treatment of the inflammatory process in cartilage, which often accompanies listhesis,
- restoration of deteriorating cartilage with chondroprotectors,
- muscle relaxation with muscle relaxants and massage,
- strengthening the muscle corset (physical therapy plays a major role in spondylosis),
- Manual therapy can partially or completely return a displaced vertebra to its place.
Recovery prognosis
It is clear that displacement of the vertebrae is always a dangerous process that can provoke many pathologies and lead to disability. Particularly serious are conditions in which the blood supply to the brain and central nervous system is disrupted. But provided that the pathology is diagnosed in a timely manner and appropriate treatment is prescribed, it is possible to quickly eliminate the disease and remove the consequences of its manifestation.
An important role is also played by which vertebra was displaced, as well as the number of damaged segments. The more discs are displaced, the later the disease is detected, the more difficult it is to return the patient to his former life. It is especially difficult for patients to recover after surgical interventions.
Surgery for anthespondylolisthesis
At stages 3 and 4 of the disease, surgical intervention may be prescribed. The operation is performed in cases where the risk of complications is high, or when it is not possible to control the pain with medication.
The operation can be accessed from the front, back or side
The least traumatic method is laparoscopic intervention, in which the incision is small - no more than 5 cm. Through this incision, a laparoscope is inserted into the abdominal cavity. An operation using this technique can only be performed for uncomplicated anthespondylolisthesis.
If there are complications, the operation is performed using an anterior or posterior approach. During the intervention, special fixing structures are installed on the displaced vertebrae. If they are unstable, an axial fixation structure can be installed.
