Offset vertebrae ( spondylolisthesis ) - Causes, Symptoms and Treatment .MF .
Spondylolisthesis - this offset vertebra anteriorly due to spondylolysis (non-union congenital vertebral arch his body) or degenerative changes in the intervertebral disc.More often observed in the displacement of the 5th lumbar vertebra in relation to the sacrum.
spondylolysis is a defect in one of the lumbar vertebrae.Most often, spondylolysis develops in the fifth lumbar vertebra.In this disease there is damage (broken) vertebra legs.Leg vertebra is anatomical education, which connects the vertebral body to the facet joints.Feet vertebra involved in the formation of the spinal and foraminal openings, which are located in the neural structures (spinal cord and nerve roots).At the rear of the spondylolysis vertebra (leg, facet joint and vertebral arch) is connected to the body of the vertebra just scar tissue.In most cases, the cause of this condition is asymphytous fractured vertebra leg
term spondylolisthesis vertebra is slipping relative to the underlying forward or backward.When slipping forward developing front spondylolisthesis, while slipping back - back spondylolisthesis.In most cases it leads to the development of spondylolisthesis spondylolysis description above.The most important structures that ensure the stability of the vertebral-motor segment are disc and facet joints.When spondylolysis facet joints can not keep the vertebrae from slipping.Intervertebral disc under the influence of loads slowly stretched, thereby slipping overlying vertebra.In many cases, for several years slippage is extremely limited and does not pose a clinical problem.However, with age the degree of spondylolisthesis may increase, leading to pain in the lower back.Typically, back pain caused by spondylolisthesis, seen in patients older than 35 years.
Symptoms of spondylolisthesis
main symptom of spondylolysis and spondylolisthesis is a chronic pain in the lumbar region.However, it is not necessary that all patients with spondylolisthesis marked back pain.Spondylolisthesis simply increases the risk of chronic back pain compared to other people in the population.Spondylolysis / spondylolisthesis can lead to the development of the mechanical type pain and radicular pain (radiculopathy).The pain is caused by instability of the mechanical type vertebral-motor segment as a result of slipping vertebra.Radicular pain is caused by compression (compression) of the nerve root dense structures (bone and ligaments).The fracture site is often in excess scar tissue is formed, which can lead to compression of the nerve root in foraminarnom hole.In addition, the displacement of the overlying vertebra forward may contribute to the development of spinal stenosis.
Usually the pain of spondylolysis / spondylolisthesis is localized in the lower back, often irradiiruya in the gluteal region.Many patients back pain increases with lumbar extension.When squeezing the nerve roots, patients reported pain in the legs, which is accompanied by weakness and numbness of the limbs.
diagnosis of spondylolysis and spondylolisthesis is set according rengenografii, computed tomography or magnetic resonance imaging.In most cases the disease can be diagnosed in conventional radiography of the lumbar spine.
However, the diagnosis "spondylolisthesis" does not mean that this disease is the cause of back pain disturbing you.Back pain can be caused by a herniated disc and many other diseases.Doctor, before you establish a link pain with spondylolysis / spondylolisthesis should exclude all other probable causes of back pain.
For diagnosis doctor first examines the complaint and detailed history of the disease.
when there were pains in the back: In the course of questioning you the following questions can be asked?
nature of pain: the intensity, location, communication with the movement
whether there onemenenie and (or) the weakness of the limbs?
whether pelvic organs function disorders (defecation and urination)?
After questioning the doctor conducted a physical survey of the patient.It is the examination, palpation of the painful area, check the tendon reflexes, skin sensitivity, muscle strength, symptoms of nerve root tension.
to confirm the diagnosis is necessary to perform additional research methods.The most informative methods of studying at a spondylolisthesis spine radiography and magnetic resonance imaging (MRI).When X-rays can reveal the degree of spondylolisthesis, and perform an MRI to assess the condition of the spinal cord and nerve roots, which may be involved in the pathological process.
Treatment of spondylolisthesis
Conservative treatment of spondylolisthesis
Treatment of spondylolysis / spondylolisthesis conducted by the algorithm of treatment of pain associated with spinal instability or compression of the nerve roots.In many cases, conservative therapy is quite effective.A fundamental element of the therapy is to strengthen the back and abdominal muscles (creating a muscular corset), which reduces the severity of spinal instability.When expressed pain syndrome is assigned to medical therapy aimed at relief of pain and reduction of muscle spasm of paravertebral muscles.In acute episodes of pain physician for a short time can be assigned to wearing a corset.However, be aware that long-term use of the corset belt weakens the back muscles, which leads to an increase in spinal instability and exacerbate the process.
Surgical treatment of spondylolisthesis
indication for surgery is the inefficiency of conservative therapy in the treatment of pain.The operation is to stabilize the spine and decompressing (reducing squeezing) of neural structures.In most cases, audit and decompression of the nerve roots and the spinal cord is performed laminectomy (removal of the vertebral arch).The surgeon removes the excess scar tissue in the area of spondylolysis, which can compress the nerve roots.Further stabilization of the spine is performed to eliminate the instability of the vertebral-motor segment.