Degenerative spondylolisthesis in the lumbar spine
ANATOMY OF THE SPINE
The human spine is formed by individual vertebrae and connective tissue discs in between. The vertebrae form the spinal canal. There are seven cervical, twelve thoracic, and five lumbar vertebrae. The intervertebral discs are the link between the individual vertebral bodies.
Normal anatomy of the spine. Longitudinal section and cross sections through the cervical, thoracic and lumbar spine.
The little joints that link the vertebrae together are known as facet joints. They help to stabilize the spine and, together with the intervertebral discs, allow a certain degree of mobility of the spinal cord. The spinal canal should be wide enough to allow nerve roots to float freely in cerebrospinal fluid.
The front border of the spinal canal is built by the vertebral bodies and intervertebral discs, the side by the intervertebral joints (facets) and back by the ligamentum flavum (yellow band) and vertebral arches. Discs consist of an outer fibrous ring (annulus fibrosus), which surrounds an inner gel-like center (nucleus pulposus).
The spinal cord and nerve roots lie within the spinal canal. The spinal cord extends downwards approx. to the 1st lumbar vertebra. Below, only nerve roots are present in the spinal canal. At the level of the intervertebral disc the nerve roots pass through the neural root foramina to exit the spinal canal. The spinal cord and nerve roots conduct electric-like signals from the skin and joints to the brain, and process of movement is initiated from the brain to the muscles.
Degenerative spondylolisthesis is a vertebral slip most common in the lumbar spine, most often at the level of L4/5. It is the result of degenerative changes in the intervertebral disc, joints and ligaments causing the vertebrae to slip forward. This type of spondylolisthesis is most common among female patients over the age of 60. Unlike all other types of spondylolisthesis the degenerative spondylolystesis usually does not cause symptoms. Very often associated with spinal canal stenosis.
Degenerative spondylolisthesis L4/5
CAUSE OF SYMPTOMS
Gradually progressing inflammation and degeneration in the intervertebral joints in the lumbar spine
Acute compression of a lumbar nerve root in the spinal canal
SYMPTOMS AND SIGNS
Patients usually have no symptoms related to a degenerative spondylolisthesis. In rare cases patients may expeprience:
Tingling, shooting pain or muscle weakness (paresis) of one or both legs
Pain and stiffness in the lower back
Leg pain (pseudoradicular type)
THE DIAGNOSIS IS BASED ON Medical history Clinical exam Computer tomography Magnetic resonance imaging (MRI) Functional (dynamic) radiographs
additionally you may have to do:
Facet joints block
The treatment may be non-surgical or surgical.
Non-surgical treatment may include Nonsteroidal anti-inflammatory drugs
Immobilization with brace
WHEN SHOULD AN OPERATION BE PERFORMED?
If degenerative spondylolisthesis is accompanied by symptomatic spinal canal or neuroforaminal stenosis, it is advisable to perform decompression at the affected level. Usually, no additional fusion is required. Among patients with degenerative lumbar spinal stenosis with spondylolisthesis, decompression surgery plus fusion surgery did not result in better long-term clinical outcomes than did decompression surgery alone (PMID: 27074066
WHAT IS THE GOAL OF SURGERY?
To release the compressed nerve roots
To improve symptoms (e.g. pain reduction)
To stop the worsening of the symptoms
Eliminate painful movement in the affected spinal segments
To preserve the protective function of the spine
HOW IS SURGERY PERFORMED?
Posterior decompression of the spinal canal without fusion
Posterior decompression of the spinal canal with stabilisation
WHICH OTHER DISEASES SHOULD BE EXCLUDED (DIFFERENTIAL DIAGNOSIS)? Peripheral arterial occlusive disease (PAOD) A disease of peripheral nerves (e.g. polyneuropathy) Lower back pain Radiculitis Tumor of the spine Peripheral nerve compression syndromes Vertebral fractures
Diseases of the hip or knee Sacroiliac joint pain Disc herniation
The condition is treated by medical spetialists in the field of:
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