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Spondylolisthesis - vertebral sliding
The slippage of a vertebra is referred to in medical jargon as spondylolisthesis. Various causes can cause this deformation of the spine and cause mild to very severe discomfort in the lower back. It is also possible that those affected have no symptoms. If a spondylolisthesis is found, conservative forms of treatment are used first. In rare and severe cases, stiffening surgery on the spine may be advisable.
A brief overview
Back pain or low back pain can occur for a variety of reasons. In rare cases, vertebral sliding occurs. The following summary briefly explains what is meant by this clinical picture, while the further article provides detailed information for those affected and interested.
- definition: Spondylolisthesis is the term used to describe the sliding of a vertebra in the lower lumbar region, in which the entire spine above it also moves in its position. There are different forms and degrees of severity of this disease, the real vertebral sliding is characterized by a gap between the articular processes of a vertebral arch (spondylolysis).
- Symptoms: The light forms are often asymptomatic. If there are symptoms, these are usually back pain and lower back pain together with a feeling of being broken through, which leads to difficulties in straightening the trunk.
- causes: The causes are diverse and range from bone damage in the vertebral joint to acquired fractures or wear processes (pseudo-spondylolisthesis) to congenital malformations.
- diagnosis: A thorough orthopedic examination of the spine and special X-ray images make it possible to detect a sliding vertebra in most cases.
- treatment: Almost every treatment is primarily based on conservative therapy methods, which include back training, various physical therapies and, if necessary, pain relievers. Surgery is only considered in rare, serious cases.
- Naturopathic treatment and other alternatives: Heat therapy and other home remedies for back pain can also help with symptomatic treatment. Other alternative methods to support the healing process include homeopathic applications and Schüßler salts.
The medical term spondylolisthesis (also spondylolisthesis in German) is derived from Greek and means vertebral gliding ("spondylos" and "olisthesis"). This is a deformity or instability of the spine and back, in which a so-called sliding vertebra slides over an underlying vertebral body. The most common is a shift to the front (belly) and one speaks of a ventro or anterolisthesis. On the other hand, if the vertebra slips backwards, this is known as retrolisthesis.
When the sliding vertebra moves, its arch roots, transverse processes and the upper articular processes are also displaced, so that the entire spine section above it is also displaced.
Vertebral gliding usually occurs in the area of the lumbar spine and is divided into different shapes and forms depending on the origin (for example, congenital or acquired) and severity. The real vertebral gliding (spondylolisthesis vera) is to be distinguished as a differential diagnosis by a gap formation in the bony vertebral arch (spondylolysis) from the purely degenerative form without a gap, the so-called pseudo-spondylolisthesis. A similar clinical picture without a sliding vertebra is spondylosis.
About half of those affected with (accidentally) diagnosed spondylolysis or spondylolisthesis have no complaints. If symptoms occur, they are rather unspecific and initially difficult to distinguish from the symptoms of other spinal disorders, such as a herniated disc.
Back pain or lower back pain is usually reported. This is due to the fact that primarily the lower spine is affected with the fifth (80 percent) or fourth (15 percent) lumbar vertebrae (L5 / S1 or L4 / L5). The pain in the lumbar spine (LWS) is mostly tied to strains and movements. By exerting pressure on the spinous process of the affected lumbar vertebra, the pain can usually also be caused when the patient is at rest. There may also be a feeling of instability in the spine (feeling of breakthrough) and an increased formation of a hollow back (hyperlordosis).
If the pain radiates, for example into the buttocks and legs, this is often equated with sciatica pain. The reason for this are nerves that are pinched by the slipping of the vertebra. In very severe cases, neurological failures can also occur, which can lead, for example, to disorders of the bladder and intestinal function or sensations in the legs.
With the distinctive shapes, a kind of step on the gliding vertebra can be visible and palpable from the outside (ski jump phenomenon), with the sacrum also usually sticking out conspicuously to the rear. Other consequences can be restricted movement, incorrect posture and skeletal deformation, such as scoliosis. Sufferers sometimes have to bend their knees to stand upright or are no longer able to bend their hips. Hip pain can also occur.
The most common cause of vertebral sliding is the appearance of spondylolysis (also spondylolysis). This is the interruption of the interarticular portion (also pars interarticularis), which forms the bone section between the upper and lower articular process of a vertebral arch. This creates a gap that damages or loosens the articulated connections and thus enables them to slip. The causes of this can in turn be acquired in the course of life due to various circumstances or, in some cases, also innate.
The classification according to causes and the consideration of additional factors (among others according to Wiltse, Newman, Macnab and Rothmann) have led to the description of different forms and (sub) types. The most common classification distinguishes the following types:
- Type I - dysplastic,
- Type II - isthmic,
- Type III - degenerative,
- Type IV - traumatic,
- Type V - pathological,
- Type VI - postoperative.
A dysplastic form, also known as type I, is a congenital malformation (dysplasia) on the vertebral joints, the articular processes or, in particular, at the transition between the lumbar spine and the sacrum, which promote the sliding of a vertebral body. Most often these malformations occur together with a spina bifida.
The isthmic form (type II) mainly results from fractures (stress or fatigue fractures) of the interarticular portion of a vertebral arch (lysis gap), which can also cause an extension of this bone section. If this area has only been cartilaginous and not ossified since birth, it is a real weak point for a fracture. The congenital causes have not yet been sufficiently researched, but a certain inheritance is assumed.
Another form (type III) can result from signs of wear and tear on the vertebral joints and intervertebral discs with degenerative instability, but without a lysis gap. This form is therefore also called pseudo-spondylolisthesis. If trauma occurs in another part of the spine, outside of the interarticular portion, it is called traumatic type IV.
If the patient has a reduced bone substance that leads to the dissolution or interruption of the pars interarticularis (for example Osteogenesis imperfecta), one speaks of a pathological spondylolisthesis (type V). Another distinction (type VI) comes into play if the disease only arises as a result of spinal surgery (postoperative).
The risk factors include, above all, competitive sports, which are harmful to the spine due to frequent and intensive over-stretching and over-stretching as well as due to other extreme loads (including gymnastics, javelin throwing, dolphin swimming, weightlifting, wrestling).
If there are back complaints that require a more detailed examination, an orthopedic examination is used in most cases. If there is a presumption of vertebral sliding, it is not just the physical examination that is an important part. In order to clarify possible risk factors and causes, an exact patient survey with a sports and family history is of great importance.
If incorrect posture or misalignment of the spine is visible or palpable in the area of the lumbar spine (hyperlordosis, ski jumping hill phenomenon), the suspicion of spondylolisthesis is often obvious. As a rule, in addition to the lower back, the areas of the hip and pelvis are also taken into account in the clinical examination and examined for posture and muscles. It is typical in many cases that those affected have to support themselves to stand up.
Special function and pain tests are intended to provide further information on mobility and the individual symptoms. For example, the Schober mark can be used to easily measure the ability of the lower back to develop, and the so-called compression pain can be checked by applying light pressure on the spine. In addition, the reflexes and sensitivity are checked and, if necessary, supplemented with further neurological examinations (electromyography, measurement of nerve conduction speed). With vertebral gliding, neurological failures are frequently observed under certain movements.
In further diagnostics, an X-ray examination of the lumbar spine is primarily carried out and possibly supplemented by other imaging methods (magnetic resonance tomography, computer tomography). In rare cases, X-rays using a contrast medium (myelography) or other examinations are necessary, such as a bone scan.
With regard to possible therapy options or also to differentiate between differential diagnoses, X-rays are used to classify them into four degrees of severity according to Meyerding (1932). The vertebral body is divided directly under the sliding vertebra in the side view into four sections, each section representing a sliding of the vertebra above by 25%. The following stages are then distinguished:
- Grade I: <25%,
- Grade II: 25 to 50%,
- Grade III: 51 to 75%,
- Grade IV:> 75%.
If there is no longer any contact between the vertebrae, there is a complete sliding, what is called spondyloptosis. According to Meyerding, this corresponds to grade IV, but sometimes this is also referred to as grade V vertebral sliding. With a low level (grade I-II) and without complaints, it is not uncommon for coincidence to be found.
The treatment goals include fighting symptoms, such as alleviating or eliminating pain and possible neurological deficits, and improving or at least maintaining the severity of the diagnosed. Appropriate therapy options are basically differentiated into two forms, which are based on the present stage. In mild cases, conservative therapy is usually sufficient, in severe cases, surgical therapy may be necessary.
As a rule, those affected are first informed about various relief options for the affected spine. This includes counseling sessions regarding healthy eating and exercise, such as weight loss and avoiding harmful physical stress in everyday life (workplace, sports activities).
Drug treatment is often used for acute pain relief. Pain-relieving and anti-inflammatory drugs (analgesics, anti-inflammatory drugs) are used, sometimes also by means of local injections. Muscle relaxants are also used to relax the skeletal muscles.
Furthermore, the physical therapies are considered to be very effective. This primarily includes consistent and regular physiotherapy, especially to stabilize and relieve the spine. In this context, a back school provides important help in dealing with the disease through advice and exercises regarding correct posture in everyday life and special muscle training.
Extension treatment, in which muscles and joints are stretched and stretched with force, or electrotherapy can also be used. Sometimes a temporary step storage is useful and relieving. Custom-made shoe inserts or trunk orthoses can also provide relief and alleviate symptoms.
In any case, follow-up checks are advisable. If there is deterioration or if there is a severe form of spondylolisthesis from the beginning, surgical intervention may be necessary.
If the affected person suffers from a very pronounced and painful vertebral glide, possibly with functional impairments of the nervous system, and if previous treatment approaches have not been successful, surgery can be an option. However, age and other diseases also play a role in the consideration for or against an operative method. If the patient has reached an advanced age or has osteoporosis, this can lead to a contraindication despite the existence of the other factors.
The surgical procedure used in this disease to stiffen the affected spinal area is called spondylodesis (blockage of the vertebral body). The goal here is to restore the full resilience of the spine and, if necessary, to remedy neurological impairments. This involves interventions with or without reduction of the slipped vertebral body.
Like any other operation, this procedure also carries general risks, and it can also lead to special complications and consequences, which can lead, among other things, to restricted movement or neurological disorders.
In post-operative follow-up treatment, physiotherapy is a central component of rehabilitation and it may be necessary to wear a corset temporarily.
In addition to conservative therapy, there are also a number of methods from naturopathy that can relax muscles and relieve pain. This includes, for example, heat therapy and, especially for those with only slight back pain, some home remedies, such as a warm bath, can help. Progressive muscle relaxation can also relieve some of those affected.
What else can you do?
If there are no serious health problems that require conventional medical treatment, those affected can also consider other alternative measures to alleviate persistent symptoms. Above all, this includes homeopathy, aromatherapy or the intake of certain Schüßler salts. In any case, medical advice should be consulted beforehand and the respective treatments should be supervised in a professional manner. (tf, cs)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. rer. nat. Corinna Schultheis
- German Society for Orthopedics and Orthopedic Surgery (DGOOC): S2K guideline for specific low back pain, as of December 2017, detailed view of guidelines
- Grifka, Joachim / Krämer, Jürgen: Orthopedics Traumatology, Springer, 9th edition, 2013
- Amboss GmbH: Vortex gliding (accessed: June 26, 2019), amboss.com
- Jena University Hospital: Degenerative instability and vertebral sliding (spondylolisthesis), (access: June 26, 2019), uniklinikum-jena.de
- American Academy of Orthopedic Surgeons: Spondylolysis and Spondylolisthesis (accessed: June 26, 2019), orthoinfo.aaos.org
- National Health Service UK: Spondylolisthesis (accessed: June 26, 2019), nhs.uk
ICD codes for this disease: M43, Q76ICD codes are internationally valid encryption codes for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.