Spondylolysis – Spondylolisthesis
Spondylolysis – Spondylolisthesis – Vertebral Displacement
What it is
Non-degenerative spondylolisthesis mainly appears at a young age, sometimes beginning with spondylolysis. Both are conditions of the lumbar spine that cause chronic pain.
Spondylolisthesis refers to the displacement of a vertebra or, in other words, its slipping over another vertebra. It is the displacement of the superior vertebra in relation to the inferior vertebra.
Spondylolysis is the discontinuity of the bone between the articular processes. In this case, there is lower back pain without compression of a nerve. The pain mainly appears during walking and rotational movements.
When lower back pain occurs during adolescence, the question arises whether the child presents with spondylolysis. To rule it out, radiological examination is required.
Spondylolysis – Spondylolisthesis
Causes
1.
Stress fractures due to repeated injuries (usually in professional athletes)
2.
Severe trauma
3.
Genetically predetermined causes
Spondylolysis – Spondylolisthesis: Symptoms
Patients may be asymptomatic and discover the condition incidentally during a radiological check. If symptoms do appear, these include low back pain and sciatica.
Spondylolysis – Spondylolisthesis: Diagnosis
For the diagnosis of spondylolisthesis, X-ray, computed tomography, magnetic resonance imaging, and clinical examination are performed.
Spondylolysis – Spondylolisthesis
Types
Dysplastic
This is congenital spondylolisthesis caused by a defect in the formation of the vertebrae.
Isthmic spondylolisthesis
In this case, the defect (fracture or elongation) in a critical part of an otherwise normal vertebra causes slippage (very common in athletes). If slippage does not occur, then it is simply referred to as spondylolysis. The most common location of this form is between the fifth lumbar vertebra and the first sacral vertebra (L5/S1).
Degenerative
When the disc has undergone severe degeneration, it ceases to act as a stabilizing factor and the weight pushes the superior vertebra forward. The cartilage in the small joints at the back of the spine (facets) degenerates and the vertebral joints change. It is common in elderly patients and constitutes a normal consequence of aging. The most frequent level where it appears is between the fourth and fifth lumbar vertebrae (L4/L5).
Traumatic
Occurs when the spine is injured (fracture) and this critical area of the vertebra (pars interarticularis) “breaks”.
Pathological
The cause of the discontinuity is pathological (e.g. tumor infiltrating the bone).
Indications that the patient requires surgical treatment
1.
Pain that does not subside with conservative treatment for at least 4 months
2.
Obvious impact on social life
3.
Spondylolisthesis ≥ grade 3 in a developing skeleton
4.
Radiculopathy
5.
Neurological symptoms
Spondylolysis – Spondylolisthesis
Treatment
Treatment is divided into conservative and surgical.
Conservative treatment includes anti-inflammatory medication, physiotherapy, supportive and occasional use of a lumbar brace, physical improvement, various diagnostic and therapeutic injections, and readjustment of the patient’s activities.
If the vertebra continues to displace, then surgery is the only option. The degree of slippage and lumbar lordosis usually determine whether the surgery will be minimally invasive (MIS TLIF) or if it should be performed using the open method.
Spondylolysis – Spondylolisthesis: Surgical techniques
Spondylolisthesis correction
Spondylolisthesis correction can be performed using multiple methods. It aims at pain relief and, in cases of severe slippage, realignment of the spine. The approach selected depends on the type of deformity.
Lumbar spinal fusion
Lumbar spinal fusion is a surgical procedure addressing any instability presented in the vertebrae (e.g., spondylolysis, spinal stenosis). It is performed by a specialized spinal orthopedic surgeon who places rods and screws made of a special metal alloy such as titanium. In this way, the deformity is corrected and spinal stability is restored. Decompression of the nerves is also performed.
Minimally invasive transforaminal interbody fusion with cage
This is a minimally invasive technique in which spinal fusion is performed through small skin incisions without the need for full access that would “open” the spine. The result is a bloodless surgery with less damage to the local muscles, shorter hospitalization time, and rapid recovery.
Spondylolysis repair
Spondylolysis repair can be performed using multiple methods. It aims at pain relief and prevention of spondylolisthesis. A necessary condition is the existence of biological healing potential and it is chosen only for young patients with a recent trauma history that caused the spondylolysis.
