pathology: spondylolisthesis

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Spondylolisthesis

Definition

Slippage of a vertebral body (or the entire spinal column in a segment) ventrally (anterolisthesis), more rarely dorsally (retrolisthesis); rarely traumatic, usually congenital malformation (spondylolisthesis vera): Prerequisite is spondylolysis (damaged vertebral arch) and resulting local hypermobility, whereby the base and top plates of the vertebrae do not have the physiological pressure conditions. The result is asymmetrical growth of the vertebrae. Damaged intervertebral discs can also lead to displacement at an advanced age (pseudospondylolisthesis). Classification into degrees of Meyerding (1: less than 25% of the longitudinal diameter, 2: 25-50%, 3: 50-75%, 4: 75-100%, 5: spondyloptosis: one vertebra slips past the other). Age mostly 12-20 years. 3* more common in men, but severe cases 4* more common in girls. Prevalence: 2-4% of the German population, varies greatly worldwide: women of black skin color under 1%, Eskimos up to 54%. Localization: Lumbar spine mainly L4/L5, L5/S1. After the end of the growth phase, further progression of the juvenile form is not to be expected. 10% of women over 60 years of age have degenerative spondylolisthesis, but spondylolisthesis of over 30% is rare.

ICD S33 / M43

Cause

  1. Degenerative: changes in the intervertebral space of the vertebral joints
  2. traumatic: vertebral fractures
  3. pathological: due to bone diseases
  4. postoperative
  5. Congenital: malformed vertebral arches (e.g. partially cartilage instead of bone), especially in the L5-S1 segment (isthmic form)
  6. Fatigue fractures of the vertebrae(arches)

Predisposing

  1. cyclical, reclining exercises and sports such as trampolining, javelin throwing, gymnastics and dolphin swimming
  2. pronounced hyperlordosis of the lumbar spine, especially if the sacral plane is inclined by more than 30°, the ventral ligament structure cannot withstand this in the long term

Diagnosis

  1. X-ray, note: spondylolisthesis may be dependent on position or movement! Therefore, in case of suspicion, additional images in WS-reclination and forward bending
  2. CT to prove the bony defect (spondylolysis)
  3. MRI to assess the intervertebral discs and nerves

Symptoms

  1. Highlight: Hip lumbar extension stiffness (angle between thigh and pelvis not less than 135°)
  2. painfully restricted flexibility of the spine, lumbalgia-like pain, the pain can radiate into both legs
  3. Pain-reflective hollow cross formation
  4. Leg-related hypesthesia, paresthesia, feeling of weakness in the legs
  5. Limited flexibility of the lumbar spine
  6. local muscle tension

Complications

  1. Leg paralysis, rectal disorders due to nerve entrapment
  2. Increased risk of spondylarthrosis, facet syndrome, spinal canal stenosis and disc hernia

Therapy

  1. There is no valid guideline yet
  2. depending on whether true spondylolisthesis with spondylosis or pseudospondylolisthesis is present, e.g. with accompanying spinal canal stenosis
  3. No general sports ban, but discontinue the above-mentioned high-risk sports
  4. Regular X-ray check-ups
  5. Orthosis if necessary
  6. surgery only if necessary (risk of nerve injury due to screws and possibly greater pain due to scarring than the primary disease), i.e. :
  7. Strengthening of the back muscles, reduction of lordosis
  8. Infiltration therapy or periradicular therapy (PRT) if necessary for pain