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Spondylolisthesis (displacement and instability of the spine)

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Spondylolisthesis (displacement and instability of the spine)

Instability of the spine, displacement of the vertebrae (spondylolisthesis) is one of the states of articulation between the vertebrae (spinal motion segment) in which excessive mobility is formed, which can lead to irritation of the nerve roots, damage to the spinal cord, compression of the spinal vessels (arteries and veins).

Displacement of the vertebrae or spondylolisthesis with its instability with compression of the nerve.

The reasons for the appearance of instability of the spine and displacement of the vertebrae (spondylolisthesis) in any of its parts may be the following factors:

  • injuries (road traffic, falls from a height, lifting weights, etc.)
  • extensive surgical interventions on the spine and spinal cord (to provide access to a particular part of the spinal cord, a wide surgical field is required, which requires the operating physician to extensively remove several parts of the patient's vertebrae)
  • weakness of the articular-ligamentous apparatus
  • during pregnancy, there is a weakening of the ligaments that support the bones of the spine
  • age-related changes in bone density (osteoporosis)

The cause of spinal instability and displacement of the vertebrae (spondylolisthesis) is the weakness of the ligaments, damage to the intervertebral discs and joints.

 

Diagnosis of spinal instability and spondylolisthesis

Vertebral instability (spondylolisthesis) is diagnosed using:

  • X-ray with functional tests (flexion and extension during the examination of the lumbar or cervical spine)
  • MRI (magnetic resonance imaging) with functional tests (flexion and extension when examining the lumbar or cervical spine)
  • CT (computed tomography) of the spine

In this case, the degree and nature of spinal instability and spondylolisthesis of the spinal motion segment are visualized.

Computed tomography (CT) of the cervical spine shows the straightening of the lordosis and the displacement of the C5 vertebral body forward relative to the C6 (spondylolisthesis is indicated by the arrow) with spinal instability.

Most often, spinal instability and spondylolisthesis occurs in the following sections:

  • cervical spine - displacement of the vertebrae of the cervical spine
  • lumbosacral spine - displacement of the vertebrae of the lumbosacral spine

Displacement of the vertebrae (spondylolisthesis) can occur due to the weakness of the ligamentous apparatus of the cervical spine with a neck injury.

Types of spondylolisthesis (according to Wiltse):

  1. Dysplastic spondylolisthesis
  2. Isthmic spondylolisthesis
  3. Degenerative spondylolisthesis
  4. Traumatic spondylolisthesis
  5. Pathological spondylolisthesis
  6. Iatrogenic spondylolisthesis

 

Treatment of spinal instability and spondylolisthesis

The method of treating spinal instability and, in general, any displacement of a vertebra or several vertebrae (spondylolisthesis) depends on the degree of displacement of the vertebra and possible clinical manifestations in the patient (discomfort, pain, muscle weakness below the zone of displacement, signs of cerebral ischemia, etc.).

Conservative treatment of spinal instability and displacement of the vertebrae (spondylolisthesis) includes a variety of manipulations on the structures of the spine:

  • manual therapy (joint, muscle technique)
  • massotherapy
  • therapeutic traction of the spine
  • physiotherapy
  • exercises
  • acupuncture
  • surgical treatment

Surgical treatment of spinal instability and spondylolisthesis aims to stabilize the vertebrae with various stabilizing systems that reliably and safely support two or more adjacent vertebrae.

Surgical treatment of instability of the cervical spine by the method of anterior fusion by fixing the bodies of the cervical vertebrae with a plate.

The figure shows the operation of interbody fusion by placing a second cage, which stabilizes the lumbar vertebrae. A minimally invasive neurosurgical transforaminal approach is used on the left (after the previously inserted pedicle screw on the right).