Lumbar spondylolisthesis refers to a disease of partial or total dislocation of lumbar spine. Clinically, it is generally called sliding vertebra, and generally the upper vertebral body slips forward. The incidence of lumbar spondylolisthesis is 3~7% in Europe, but there is still a lack of accurate statistical data in China. Through the routine X-ray examination of patients with low back pain, it is generally believed that about 5% adults suffer from lumbar spondylolisthesis.
At present, the cause of lumbar spondylolisthesis is not clear. The most common cause of lumbar spondylolisthesis is degenerative spondylolisthesis with age, also known as pseudospondylolisthesis; Secondly, sports injury, congenital or unexplained lumbar spondylolisthesis, also known as true spondylolisthesis; Lumbar spondylolisthesis often occurs between the 4th and 5th lumbar vertebrae and between the 5th and 5th sacrum 1.
Degenerative lumbar spondylolisthesis is caused by long-term and persistent lumbar instability, which makes the corresponding small joints degenerate and the joints suddenly become horizontal. The degeneration of intervertebral discs makes the connection between vertebrae loose and unstable, and gradually leads to lumbar spondylolisthesis. This disease is also called pseudospondylolisthesis because the isthmus remains intact. More common after the age of 50, women are more than men, and most of them occur in the forward movement of lumbar vertebra 4, followed by the forward movement of lumbar vertebra 5. Degenerative lumbar spondylolisthesis is generally mild, mostly within 2 degrees.
The real lumbar spondylolisthesis is caused by isthmus fissure. The cause of isthmus fissure is not clear at present, which may be related to the narrow and weak isthmus during the development of lumbar spine. On this basis, the isthmus is prone to fatigue fracture and fracture, and then the fracture does not heal, leading to isthmus cracking. Spondylolysis may not necessarily be accompanied by lumbar spondylolisthesis, but the degree of lumbar spondylolisthesis formed after spondylolysis may be very heavy. True lumbar spondylolisthesis is most common in adults under 40 years old, but rare in children.
Lumbar spondylolisthesis is mostly asymptomatic and is often found unintentionally during physical examination. Some patients also found lumbar spondylolisthesis when taking X-ray films of low back pain. The symptoms of patients are related to the type of lumbar spondylolisthesis, the stability of spine, the degree of spondylolisthesis and age.
Not every patient with spondylolisthesis and isthmus rupture needs treatment. Only 30% patients with lumbar spondylolisthesis diagnosed by X-ray will have symptoms. For asymptomatic spondylolisthesis and degenerative spondylolisthesis found by chance, there is no need to treat them, but only need to strengthen back muscle exercise, enhance lumbar stability, and prevent the aggravation of spondylolisthesis, as well as low back pain, radiation pain and numbness of both lower limbs.
Most patients with lumbar spondylolisthesis only have low back pain, and conservative treatment can effectively alleviate the symptoms. The contents include bed rest, waist hot compress physical therapy, waist circumference fixation, oral anti-inflammatory and analgesic drugs, traditional Chinese medicine for promoting blood circulation and removing blood stasis, and strengthening muscle exercise of the back. Only a few young patients need surgery because of lumbar spondylolisthesis with recurrent low back pain.
Lumbar spondylolisthesis can lead to lumbar spinal stenosis, compression of lumbar nerve roots, radiation pain, numbness of both lower limbs, intermittent claudication and other symptoms. In severe cases, the patient cannot walk. Degenerative spondylolisthesis is one of the important causes of lumbar spinal stenosis. This is a progressive disease and generally does not stabilize itself. Most patients are ineffective in conservative treatment and need surgery to effectively alleviate the above symptoms.
When you find your waist uncomfortable, you should go to the hospital for treatment. The general auxiliary examination is not expensive, and the diagnosis can be made by ordinary X-ray plain film or lumbar biconvex image. However, when the condition is complicated, such as lumbar disc herniation, lumbar spinal canal stenosis or excluding lumbar lesions, it is necessary to take a further extension and flexion film of the lumbar spine to observe the stability of the spondylolisthesis, and to do CT and MRI to understand the compression of nerve roots.
Different types of lumbar spondylolisthesis have different surgical methods. Doctors should put forward reasonable treatment suggestions according to the specific situation of patients. At present, the surgical treatment principles of lumbar spondylolisthesis are reduction, decompression, internal fixation and bone graft fusion. Reduction refers to the method 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 enlargement and other methods to relieve the compression of nerve roots and cauda equina, and relieve the symptoms of pain and numbness in patients' lower limbs; Internal fixation refers to the use of appropriate internal fixation methods to maintain the normal position of the vertebral body and prevent the recurrence of lumbar spondylolisthesis or lumbar instability. But internal fixation can only provide short-term stability after lumbar surgery, and its long-term stability ultimately depends on bone graft fusion. At present, most orthopedic surgeons can achieve the above goal by using pedicle screw fixation system. Some patients may use interbody fusion cage alone or at the same time to enhance the stability of the spine after operation and improve the fusion rate of spinal bone graft. A large number of clinical cases have proved that these operations have ideal effects and high patient satisfaction, and have become mature standard operations.