When vertebral bodies "dance out of line"

The term Spondylolisthesis refers to the displacement (slippage) of a vertebral body together with its arch roots, transverse processes, and upper articular processes. The segment may slide over the next lower vertebra to the front (anterolisthesis) or to the back (retrolisthesis). The main consequence of this phenomenon is instability of the spine, often accompanied by back pain which can also radiates to the legs. The 5th lumbar vertebrae is most frequently affected one (80%) followed by the 4th lumbar vertebrae (15%). More than half of all sufferers have atypical / unclear symptoms for a long time, which is why only an accurate diagnosis can help. At around 2-4 %, the vertebral dislocation remains symptom-free and therefore goes unnoticed.

Causes of vertebral displacement

Normally, the spine forms a smooth, light S-curve, to which all components adapt. When we talk about vertebral displacement, one or more vertebrae slip out of their normal position.

This instability can have various causes: On the one hand, there could be a congenital deformation of the spinal column; on the other hand - gradual changes such as wear, bone loss or previous fractures. Age-related changes of the intervertebral discs as well as the wear of the vertebral bodies are the most common cause of vertebral dislocation. Statistics show that people between the 50th and 60th year of life are the most affected ones. Over the years, the intervertebral discs, which serve as shock absorbers between the individual vertebrae, lose their fluidity and volume and become more and more compressed, correspondingly close one another, and tendons and ligaments relay themselves. The spinal segments become unstable. The single vertebra is no longer held and can easily slip out of the existing formation. Well-trained ligaments, muscles and tendons slow down these movements because they provide extra support.

In a few cases, a Listhesis can also be triggered by the overuse of the spine in competitive sports. Art gymnastics, pole vaulters or dolphin style swimmers are particularly at risk of vertebral displacement. Severe injuries, such as traffic accidents, can also seriously affect the stability of the spine and make the vertebrae slip.

Basically, four severity levels of vertebral dislocation can be distinguished (categorization according to Meyerding):

  • Grade 1: less than 25% shifted
     
  • Grade 2: 25 to 50%
     
  • Grade 3: 51 to 75%
     
  • Grade 4: more than 75% shifted

Symptoms of spinal displacement

The development from grade 1 to grade 4 is usually gradual in vertebral displacement. Only in rare cases they come to a sudden deterioration. As a rule, however, stress and long-term pain occur in the advanced stage. Depending on the strength of the vertebral dislocation, one or more nerves in the spinal canal can be pinched and stretched. This can cause nerve damage to the point of its failure. This in turn can cause a paralysis that affects both: legs and bladder and bowel function. At the same time, intervertebral disc (herniated disc) and vertebral joint (spondylarthrosis) wear out, causing severe pain. It is not uncommon for patients to feel tingling, numbness and/or weakness.

Diagnosis of vertebral displacement

Even an X-ray image can clearly show when a vertebra is displaced. However, what is incredible is that it is often found out just as a coincidence. If the dislocated vertebra does not press on a nerve, the displacement is largely without pain and/or any symptoms. It can also cause chronic and severe back pain in the lower back (L-spine) - especially if further damage to the spine (also into the cervical spine) and the intervertebral discs are affected. Precise diagnostics therefore require a whole package of measures. First of all, of course, there is the detailed interview with the patient (anamnesis). Here, the specialist asks especially about any stress related to the patient's personal life or the performance of certain sports. In addition, there is a thorough examination of the spine, including findings on the patient's posture, the lumbar spine displacement formation, the pelvic assessment, and the intensity of pain.

Functional and pain tests, CT or MRI diagnostics, spine measurement, EMG and discography complete the perfect picture for the diagnosis of a vertebral displacement.

Therapy of vertebral displacement

In some cases a treatment with conservative therapeutic therapies is sufficient to alleviate the discomfort caused by a spondylolisthesis but our aim is to stabilize the spine. As part of a physiotherapeutic treatment, we strengthen the muscles or the patient temporarily receives a corset, which will keep his back in the right shape. However, the conservative therapy is not able to treat the disease itself (spondylolisthesis) causally.

If the discomfort and pain persist for longer and if there are weakness, numbness or bladder dysfunction we achieve a lasting stabilization of the affected vertebral segments with surgery (spondylodesis - blocking or stiffening- fixation). With this surgical method, we not only stabilize the joint, but also eliminate any present narrowing, correct the position of the slipped vertebrae (reposition) and free the pinched nerves (decompression).

The interlocking of the spine is carried out by means of titanium elements in order to stabilize the loose segment. During the operation, under general anesthesia screws are inserted into the vertebral bodies and fixed using connecting elements.

Sometimes it is necessary to replace the damaged discs with bone blocks, titanium implants or synthetics cages. Usually we correct the position of the vertebrae in the same session. A few months after the procedure, the vertebral joints fuse themselves with the blocks or cages used. Thus, a stiffening of the affected section is achieved.

As a result, the instability is eliminated and the pain significantly alleviated. Only at that point there is another opportunity for conservative therapy to strengthen the back muscles. Of course, after such an intervention, patients can continue to perform all desired back movements - often even better than before.

Dr. med. Munther Sabarini

Author
Dr. med. Munther Sabarini
Specialist in Neurosurgery

Hans-Heinrich Reichelt

Co-author
Hans-Heinrich Reichelt
Chief Editor of Medizin für Menschen

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Since the year 2001, the Avicenna Clinic is based in Berlin. Our doctors have at least 25 years of international experience in their respective fields (neurosurgery, spinal surgery, anesthesia, and orthopedics).

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