In this article we will talk about two pathologies of the spine: spondylolisthesis and spondylolysis. We are going to learn more about what is this pathology and learn about its treatments and recommendations.
What are spondylolisthesis and spondylolysis all about? By “lysis” we refer to the breakage of one of the parts of the vertebrae. This break can occur in:
- Pars interarticularis
On the other hand, the “listhesis” (degenerative spondylolisthesis) is the displacement of one vertebra over the other, towards the anterior or posterior face.
- Previous: Antherolysis
- Posterior: Retrolisthesis
There is a Mayerding Classification that can be grade I, II, III, or IV, depending on the percentage of displacement. The higher the percentage of displacement, the more compromise and the worse the prognosis this injury will have.
Normally, rupture (lysis) usually occurs first and then displacement occurs since, with rupture, we compromise the stability of the vertebrae, and an unstable vertebra is a hypermobile vertebra. Therefore, it tends to move more easily.
Where do these displacements normally occur?
It usually occurs in – in general – in the L4 – L5 and L5 – S1 vertebra. This is at the lower lumbar level. We also know that at the level of the sacrum it is much more fixed than at the level of the vertebrae. Therefore, if we have a very stable segment and another that is mobile, and if we also have fracture or instability, then the slip will be greater.
The vertebral line of the fifth lumbar is inclined, which favors this displacement even more. This shift of L4 – L5 is seen even more in older adults and L5 – S1 in younger people.
Other data that we can offer on this type of pathology is that it is very prevalent since worldwide it has been recorded that up to 4.2 percent of the population suffers from spondylolisthesis. This has been classified into six subtypes and the most investigated and prevalent is degenerative.
What are the causes of spondylolisthesis and spondylolysis?
The causes can be:
Congenital: Malformations of the spine, malformations of the spine in which – either because part of the vertebra has been formed – with greater distance, greater dysplasia, or because that part has not been fully consolidated, causes that vertebral segment is more unstable.
Repetitive microtrauma: It occurs in elite athletes, especially in sports such as shot put, artistic gymnastics, and rowing. It has been seen that 8.2 percent of these elite athletes have a spondylolisthesis.
Symptoms: What does it feel like when you have this pathology?
Many times, it is possible that anyone is going through a spondylolisthesis and is not aware of it because 80% of spondylolisthesis is asymptomatic because these conditions are grade I, where the displacement is from 0 to 25 percent of the vertebra and that our body – within everything – tolerates it quite well.
However, there are the other higher degrees (II – III – IV) where even the displacement can be total. Here we already enter into complications, for example, lumbar pain that, if it gets worse, drifts towards the lower limbs and we start discomfort, and the worst thing for a patient would be to present a neuropathic pathology, which compromises the sensitivity and motor skills of the legs.
This is a red flag for immediate surgery, especially if the patient has:
- Lack of sensitivity
- Lack of motor pattern
- Gallbladder failure
- Failure in the intestines
- Bladder failure
- Treatments for spondylolisthesis
Treatments for spondylolisthesis
Thanks to the advancement of science and medicine, the treatment is not only surgical. There is also a conservative treatment in which it is recommended – especially in low degrees of spondylolisthesis since its effectiveness has been investigated.
This conservative treatment consists of a change in sports life since if we avoid certain types of movements or certain sports that can aggravate this spondylolisthesis, we will try to contain the displacement by preventing it from being greater.
Continuing with this line, we find the therapeutic exercise that has to be prescribed by your physiotherapist individually to improve your condition. It has also been seen how in some cases the use of a corset in children also retains the advancement of spondylolisthesis since, having support and stability of the trunk, although it still has some controversy.
Education: If you are aware of this pathology, how it is avoided, how it improves, how it worsens, and see why you feel a certain pain, you have to be alert to know how to avoid progress and, if applicable, for recovery and maintenance of this pathology.
Pain treatment: We can use physiotherapy techniques such as electrostimulation to try to modulate pain.
It is worth commenting that, as we get older, our vertebrae become more rigid, and that, despite having its drawbacks, also has a point in its favor: it prevents them from moving more easily.
On the other hand, it has been shown that in 1o and 11-year-old children, the displacement of spondylolisthesis, after 44 years of follow-up (when these children are already 54 years old) was seen how the displacement had been only 7 percent and that this displacement was less and less decade after decade.
What happens if the pain does not decrease if the symptoms get worse and worse despite having attended treatment with the physiotherapist for many months? In this case, surgical treatment remains.
It is recommended especially for advanced degrees and where conservative treatment has failed with a minimum of three to six months, and especially if it is urgent, when there is claudication, sensory and motor impairment, or when the nerves are compromised.
Do not be afraid to move. The first thing we have to know is the degree of affectation we have. If it is a grade I, the displacement is minimal, and it may not wake up in any type of symptomatology and we should not panic.
Also, if you have been diagnosed with spondylolisthesis, good movement and good practices will sustainably benefit you.
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