Print Spondylolisthesis, or the forward slip of a vertebra over the one beneath it, involves several main parts of your vertebrae. First off, the vertebrae are the bones that make up your spine. Most people have 33 vertebrae in their spinal column.
Pashman Isthmic Spondylolisthesis Spondylolisthesis refers to the relative translation of adjacent Vertebra in the spine. Anteriorlisthesis means forward translation of the upper vertebra. Although spondylolisthesis can be caused by various pathologic states in the spine, Isthmic Spondylolisthesis is produced when bones pars interarticularis connecting the facet joints in the posterior spine are fractured causing anteriolisthesis of the vertebra.
The pars serves as a checkrein for translation movement of the vertebra and when fractured, the vertebra are allowed to move past each other producing symptoms ranging from mild low back ache to severe neurologic deficits.
Although L5-S1 is most commonly affected, isthmic spondylolisthesis has been found at every lumbar level. Why the pars fractures is incompletely understood, but research has revealed some telling facts.
Pars fractures interestingly have not been found in two populations of humans: Moreover, pars fractures are found in increased frequency in athletes who hyperextend their spine such as gymnasts and football inside lineman.
These facts taken together indicate that pars fractures are in fact stress fractures produced when the predisposed, weakened pars interarticulars is subjected to repetitive hyperextension forces. Why certain patients become variably symptomatic is unknown. The magnitude of symptoms caused by spondylolisthesis does correlate with the degree of anteriolisthesis of the vertebra.
A grading system has been defined to characterize the degree of slip: A grade 5 slip means that the vertebra has completely dislocated off the lower vertebra. In general, grade 4 slips may present with more low back pain and neurological problems than a grade 1 slip, although this rule does have exceptions.
Low back pain and nerve compression symptoms are found in patients with isthmic spondylolisthesis. For the same reason that the vertebra translate relative to each other, the pars fracture permits abnormal vertebral motion creating low back pain. Chronic tearing and degeneration of the disc may actually be the pain generator, but this has never been proven.
This chronic abnormal motion sometimes referred to as instability also creates a situation where the pars fracture cannot heal. New bone forms around the fracture and may actually compress the nerves which pass in proximity.
This compression, plus the nerve stretch caused by the forward motion of the vertebra, is responsible for the nerve irritation and leg pain.
Treatment is designed to stop either the progression of the slip or the abnormal motion which creates pain. As with most spinal problems, children are treated for different reasons than adults.
In children, low back pain and associated nerve irritation causing leg pain and hamstring tightness can initially be treated by rest and cessation of athletic activity.
In some cases, bracing may be attempted. Documented progression of the slip and pain refractory to conservative measures are indications for surgery. Adults should initially be treated with rest, anti-inflammatories, and physical therapy as symptoms subside.
Slippage does not usually progress in adults.
It is for this reason that serial neurological examinations should be performed during the course of conservative treatment. Patients with symptoms refractory to conservative treatment may be candidates for surgery.
The current state of the art is fusion surgery for isthmic spondylolisthesis. To view an animation of the surgery, click here How this fusion will be done depends on multiple factors.
As the vertebra translates, it also tilts producing the characteristic slip angle. The slip angle produces kyphosis in the lumbar spine which may need to be corrected if severe.Nov 02, · Why Avoid Back Surgery at all Costs-Try this instead. Avoid Back Fusions.
- Duration: Physical Therapy Video 67, views. Spondylolisthesis is a slipping of vertebra that occurs, in most cases, at the base of the spine. Spondylolysis, which is a defect or fracture of one or both wing-shaped parts of a vertebra, can.
Please try again hed on feb 28, this is an animation of how intervertebral disc degeneration and height loss causes forward slippage of one vertebra upon another with subsequent repetitive irritation or nipping of the exiting nerve and back pain and referred pain.
Degenerative spondylolisthesis is a condition in which one vertebral body slips forward on top of the vertebral body below it, as a result of aging processes that weaken the spine. Spine surgery for spondylolisthesis is a much-debated topic. While most surgeons agree that decompression of the nerves may benefit the patient, the question is whether the slipped vertebra needs to be realigned at all.
Spondylolisthesis Symptoms and Causes Video. Spondylolisthesis is a condition in which a defect in a part of the spine causes vertebra to slip to one side of the body. Typical symptoms of spondylolisthesis include back pain and/or leg pain.