Doctors and experts please come in!!!!
Lumbar spondylolisthesis can easily lead to chronic low back pain and radiating numbness and pain in one or both lower limbs.
Lumbar spondylolisthesis refers to a disease in which the intervertebral bodies of the lumbar vertebrae are partially or completely dislocated. Clinically, it is generally called spondylolisthesis, and it is usually the upper vertebral body that slips forward. The incidence of lumbar spondylolisthesis in Europe is 3 to 7. There is still a lack of accurate statistical data in China. It is generally believed that routine X-ray examination of patients with low back pain shows that about 50% of adults have a tendency to suffer from lumbar spondylolisthesis.
At present, the cause of lumbar spondylolisthesis is still unclear. The most common cause of lumbar spondylolisthesis is degenerative lumbar spondylolisthesis that occurs with age, also known as pseudo spondylolisthesis; secondly, lumbar spondylolisthesis caused by sports injury, congenital or unknown reasons causing lumbar isthmus collapse, also known as true spondylolisthesis; Lumbar spondylolisthesis usually occurs between the 4th and 5th lumbar vertebrae and between the 5th lumbar and sacral 1st vertebrae.
Degenerative lumbar spondylolisthesis is due to long-term and sustained instability of the lumbar spine, which causes degenerative changes in the corresponding small joints, the joints suddenly become horizontal, and the degeneration of the intervertebral discs causes the connection between the vertebrae to become Relaxation is unstable, and spondylolisthesis gradually occurs. This disease is also called pseudoslip because the isthmus remains intact. It is more common after the age of 50 and is more common in women than men. It mostly occurs in forward slippage of the 4th lumbar vertebrae, followed by forward slippage of the 5th lumbar vertebrae. The degree of degenerative lumbar spondylolisthesis is generally relatively mild, mostly within 2 degrees.
True lumbar spondylolisthesis is caused by isthmus collapse. The cause of isthmus collapse is not yet clear. It may be related to the narrow and weak isthmus during the development of lumbar vertebrae. On this basis, the isthmus is prone to fatigue fracture and fracture. Later, the fracture did not heal, resulting in isthmus collapse. Isthmic rupture may not be accompanied by lumbar spondylolisthesis, but the degree of lumbar spondylolisthesis formed after isthmic rupture can be severe. True lumbar spondylolisthesis is most common in adults under 40 years old and is rare in children.
Most lumbar spondylolisthesis is asymptomatic and is often discovered accidentally during physical examination and X-rays. Some patients are also found to have lumbar spondylolisthesis when taking X-rays when they seek treatment for low back pain. The patient's symptoms are related to factors such as the type of spondylolisthesis, the stability of the spine, the degree of spondylolisthesis, and age.
Not every patient with spondylolisthesis and isthmic dehiscence requires treatment. Only 30% of patients with X-ray confirmed spondylolisthesis will develop symptoms. For isthmic spondylolisthesis and degenerative lumbar spondylolisthesis accidentally discovered without symptoms, no treatment is required. It is only necessary to strengthen the lumbar back muscle exercises to enhance the stability of the lumbar spine and prevent further aggravation of the spondylolisthesis, as well as the resulting low back pain and radioactivity of both lower limbs. Symptoms such as pain and numbness.
Most patients with lumbar spondylolisthesis who only have low back pain can effectively relieve their symptoms through conservative treatment. The content includes bed rest, waist hot compress physiotherapy, waist circumference fixation, oral anti-inflammatory and analgesic drugs, Chinese medicine for promoting blood circulation and removing blood clots, as well as strengthening exercises for the lower back muscles. Only a few young patients with isthmic spondylolisthesis accompanied by recurrent low back pain require surgical treatment.
Due to lumbar spondylolisthesis, lumbar spinal canal stenosis may occur, compressing the lumbar nerve roots, resulting in symptoms such as radiating pain, numbness, and intermittent claudication in both lower limbs. In severe cases, patients may be unable to walk. Degenerative lumbar spondylolisthesis is one of the important causes of lumbar spinal stenosis. It is a progressive disease that generally does not stabilize on its own. Most patients are ineffective in conservative treatment and require surgery to effectively relieve the above symptoms.
When you find waist discomfort, you should go to the hospital for treatment. General auxiliary examinations are not very expensive. Ordinary plain X-rays or double oblique images of the lumbar spine can make a clear diagnosis. However, when the condition is complicated, such as combined with lumbar disc herniation, lumbar spinal stenosis, or lumbar spinal disease is ruled out, further lumbar hyperextension and flexion radiographs should be taken to observe the stability of the slipped vertebral body. CT, MRI, etc. are also required. Examine for nerve root compression.
There are different surgical methods for different types of lumbar spondylolisthesis. Doctors should make reasonable treatment suggestions based on the patient's specific situation. The current surgical treatment principles for lumbar spondylolisthesis are: reduction, decompression, internal fixation, and bone grafting and fusion.
Reduction refers to the use of surgical release combined with instruments to restore the slipped vertebral body to its original normal position; decompression in most cases refers to the use of laminectomy, nerve root canal opening and other methods to relieve the pressure on the nerve root and cauda equina nerve. compression to relieve the patient's symptoms of pain and numbness in the lower limbs; internal fixation refers to the use of appropriate internal fixation methods to maintain the normal position of the restored vertebral body and prevent recurrence of spondylolisthesis or instability of the lumbar spine. However, internal fixation can only provide lumbar vertebrae. Short-term stability after surgery, and long-term stability ultimately require bone graft fusion to achieve. At present, most orthopedic surgeons use pedicle screw fixation systems to achieve the above purposes. Some patients may use intervertebral cages alone or at the same time to enhance the stability of the spine after surgery and enhance the rate of spinal bone grafting and fusion. Confirmed by a large number of clinical cases, these surgeries have relatively satisfactory results and high patient satisfaction, and have become mature standard surgeries.