Spondylolisthesis (Listhesis)

What is vertebral slippage (spondylolisthesis)?

Vertebral slippage, also known as spondylolisthesis or simply listhesis, is the sliding of a vertebra along with its arch roots, transverse processes and superior articular processes. Vertebral slippage is a sign of spinal instability. In this case, a vertebra can slide forward (anterolisthesis) or backward (retrolisthesis) over the next lower vertebra.

A slipped vertebra is almost always associated with a narrowing of the spinal canal, and rarely with ganglion cysts. The 5th lumbar vertebra is the most commonly affected, accounting for 80 percent, and the 4th lumbar vertebra is the second most commonly affected, accounting for 15 percent. More than half of all affected persons have atypical or unclear symptoms for a long time, which is why only precise diagnostics can help and identify spondylolisthesis. In about 2-4 percent, spondylolisthesis remains symptom-free and therefore unnoticed.

Symptoms of spondylolisthesis

The development of spondylolisthesis from grade 1 to grade 4 is gradual. In principle, only the patient can know how insidiously the spondylolisthesis has developed. In the anamnesis interview, the patient describes to the physician when and with what pain the problem began, for example in the lumbar spine.

In any case, a gradual process does not consist of weeks, but rather of months or even years. Only in rare cases can there be a sudden worsening of spondylolisthesis. The first signs of spondylolisthesis (spondylos = the vertebra and olisthesis = the sliding) can be tingling and numbness in addition to back pain and leg pain. Usually, in the advanced stage, pain on exertion and continuous pain occur. Preferably, these are severe pains after standing up or when turning around. During the day, the back pain usually increases.

Toxic for spondylolisthesis is carrying heavy objects. Depending on the severity of spondylolisthesis, vertebrae may rub against each other, and in the long term, single or multiple nerves in the spinal canal/vertebral canal may become pinched and stretched. There is also a risk of spinal stenosis, a narrowing in the spinal canal. In case of such complaints and symptoms, you should definitely consult a specialist. Slipped vertebrae, as the saying goes, should not be taken lightly.

Dr. Munther Sabarini: "The aforementioned complaints can cause nerve damage up to the functional loss of a nerve. This, in turn, can cause paralysis that affects the legs as well as the function of the bladder and bowel. At the same time, the intervertebral disc (herniated disc) and vertebral joint (spondylarthrosis) wear out, which can sometimes cause severe pain. Slipped vertebrae therefore need urgent treatment."

Causes of vertebral slippage

Normally, the spine forms a smooth, gentle S-curve to which all components conform. Stability is provided by a strong muscle-tendon system. In slipped vertebrae, or spondylolisthesis, one or more vertebrae slip out of their normal position.

There are various causes of spondylolisthesis: On the one hand, congenital deformations of the spine cause the vertebrae to slide out of their usual position. On the other hand, gradual changes such as wear and tear, bone resorption or previous fractures also lead to slipped vertebrae. Age-related changes in the intervertebral discs (degeneration) as well as wear and tear on the vertebrae and joints (spondyloarthrosis) and weakened back muscles are the most common causes of spondylolisthesis.

Extensive spinal surgery can lead to instability in the back. People between the ages of 50 and 60 are often affected. This is because over the years the intervertebral discs, which act as shock absorbers between the individual vertebrae, lose fluid and thus volume. They are compressed more and more, are correspondingly closer together, and tendons and ligaments become loose. The segments of the spinal column thus become unstable. The individual vertebra is no longer held in place and can slip out of its existing position more easily. Well-developed ligaments, muscles and tendons slow down the displacement because they provide additional support in the spinal canal.In a few cases, listhesis can also be triggered by the overuse of the spine in competitive sports. Artistic gymnasts, pole vaulters or dolphin swimmers are particularly at risk. Serious injuries, caused for example by traffic accidents, can also severely impair the stability of the spine and cause the vertebrae to slip.

Diagnosis of vertebral slippage

Vertebral slippage can occur in all areas of the spine. Even an x-ray of the back could show vertebral slippage. X-rays in flexed and extended positions (flexion and anti-flexion) are necessary to confirm the diagnosis. If the slipped vertebra does not press on a nerve or directly on an intervertebral disc, vertebral slippage proceeds largely without pain or symptoms in the vast majority of patients. However, it can also result in chronic, deep-seated pain in the lower back (lumbar spine) - especially if further damage to the spine (including cervical spine) and intervertebral discs is triggered.

Accurate diagnostics therefore include a whole package of measures. This is important in order to differentiate the slipped vertebra from other diseases. In addition to the neurological-orthopedic examination, the first step before treatment is, of course, always a detailed patient interview (anamnesis). Here, the doctor also asks in particular about family strains or certain types of sport. He checks sensitivity, motor skills and reflexes to rule out damage to the nerves.

Functional and pain tests, CT or MRI diagnostics, complete the picture for the diagnosis of spondylolisthesis. What is special about magnetic resonance imaging (MRI) is that this technique can be used to visualize and see nerve roots, intervertebral discs, tendons and ligaments.

Therapies for spondylolisthesis - this is how your specialist will help you

In some cases, treatment with conservative therapeutic therapies is sufficient to relieve symptoms. As long as there are no neurological deficits such as paralysis, we always favor good conservative treatment. In addition to treating the pain, we aim to stabilize the spine. As part of physiotherapy and back training, we strengthen the muscles in the back for the purpose of rapid mobilization, or the patient is temporarily fitted with a corset to keep the back in the correct shape. However, conservative therapy is not able to treat the disease itself (spondylolisthesis) causally or to reverse the spondylolisthesis.

If the discomfort and pain persist for a longer period of time, or if there are already deficits, we achieve good results in certain cases with a microsurgical operation. This improvement occurs by freeing the pinched nerves (decompression) and eliminating the narrowing and constriction. In other cases, spondylodesis (locking or stiffening) is necessary in addition to decompression. With spondylodesis for spondylolisthesis, we free the pinched nerves (decompression), eliminate narrowing (stenosis), correct the position of the slipped vertebra (reduction) and stiffen the segment.

We realize the blocking of the spine by means of elements made of titanium in order to stabilize loosened movement segments. During surgery, screws are inserted into the vertebral bodies and fixed with connecting elements. The use of the body's own bone material provides more stability. A few months after the operation, the vertebral joints fuse with the inserted blocks or chips. Thus, the affected section is successfully stiffened. Rarely, a disc replacement is necessary. In patients with allergy to titanium, implants made of carbon are used.

This eliminates the loosening, and the pain is significantly relieved. Only then is there again a possibility for conservative therapy to strengthen the back muscles. After such an intervention, patients can of course continue to perform all desired back movements (including sports) - often even better than before.

Dr. med. Munther Sabarini

Author
Dr. med. Munther Sabarini
Specialist in Neurosurgery

information about the article

The article was last checked and updated on 06.12.2021.

About the author

Dr. med. Munther Sabarini, MD, is the director and founder of the Avicenna Clinic. As a specialist neurosurgeon, he particularly has expertise in the treatment of spinal disorders. Dr. Munther Sabarini has more than 30 years of professional experience. During this time he treated more than 30,000 patients.

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