What is spondylolisthesis?

Spondylolisthesis It is a disease that occurs when a vertebra is displaced in relation to adjacent vertebrae.

Some medical dictionaries define spondylolisthesis specifically as anterior displacement of a vertebra, although it is also commonly defined as displacement in either direction and anterior displacement is referred to as anterolisthesis and backward displacement retrolisthesis and lateral displacement laterolisthesis.

It should not be confused with spondylosis or spondylitis, both are diseases that affect the intervertebral discs and may or may not be accompanied by vertebral displacement.

Grade IV spondylolisthesis affecting the L5-S1 vertebrae

Causes

The most common cause of spondylolisthesis is an evolution of anterior spondylolysis. Spondylolysis is a fracture in the interarticular isthmus that can affect one or both sides of a vertebra.

Spondylolysis can go unnoticed without symptoms in many cases and favors displacement between one vertebra and another, which gives rise to spondylolisthesis (isthmic spondylolisthesis).

On other occasions, the vertebral joint in certain segments of the back is of a different size from the other segments, causing the vertebra to not be correctly aligned with the others.

The different size of the joint may be due to a congenital malformation, in which case spondylolisthesis is observed from childhood. In other cases it is due to joint wear and tear, in which case spondylolisthesis is seen as the person ages (degenerative spondylolisthesis).

Spondylolisthesis can also be caused by trauma that causes some vertebrae to displace in relation to others.

Spondylolisthesis can affect any part of the spine, although it is more common in the lumbar segments, especially in degenerative, isthmic and traumatic spondylolisthesis.

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types

Spondylolisthesis is classified based on several criteria. Depending on the direction of displacement of the vertebrae, it can be anterolisthesis, retrolisthesis or laterolisthesis.

According to him, the degree of displacement, measured as a percentage of the width of the vertebral body, is numbered from I to V:

Grade I: 0-25% Grade II: 25-50% Grade III: 50-75% Grade IV: 75-100% Grade V: displacement greater than 100% Measurement of the degree of spondylolisthesis on an x-ray

It is also classified according to the cause into:

degenerative: It is produced by the degeneration of the tissues that support the vertebrae, such as ligaments and intervertebral discs. isthmic: caused by the evolution of a spondylolysis. Congenital Traumatic: It is a spondylolisthesis that is present from birth. pathological: due to bone disease. latrogenic: In this case, spondylolisthesis is a consequence of medical treatment.

Symptoms

The main symptom of spondylolisthesis is back pain, although grades I and II are usually asymptomatic and its diagnosis is usually casual when x-rays are taken for other reasons.

In addition to pain, spondylolisthesis can cause weakness and numbness if it pinches a nerve (radiculopathy). In these cases the pain can be very intense, disabling and radiate to the extremities.

diagnosis and treatment

The treatment of spondylolisthesis in its lower grades (I-II) is usually a conservative treatment based on personalized physical exercises for each patient that seeks to interrupt the evolution and progression of the displacement of the vertebrae.

It is often accompanied by physical therapy and analgesic pharmacology for pain control.

In the most severe cases, surgical treatment is used. Surgery is usually reserved for grades III, IV, and V with radiculopathy.

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