Spondylolisthesis

What is spondylolisthesis?

It is a pathology originating in the spine in which at least two factors are present: a joint injury (vertebral factor) and a displacement (unstable factor). It consists of a joint injury caused by a fissure or fracture (hence the term lysis), which in itself produces pain. However, like spondylolysis, when present in an environment with healthy muscles and joint tissues such as ligaments and cartilage, it can simply manifest as lower back pain. In the most severe cases, it can cause neurological involvement, producing symptoms similar to those of lumbosciatica.

How does spondylolisthesis occur?

They are difficult to identify and diagnose, except in cases of direct trauma, but spondylolisthesis symptoms usually progress over time and the initial stage may not be known.

It is thought that spondylosis occurs first, and although it has shown improvement in the acute phase, the joint may show residual mobility that is ultimately inadequate and allows displacement, presenting the factor of instability.

The injury is classified into severity levels (1-5) based on the distance it has shifted from the anatomical equilibrium point, the correct position. This shifting may progress and gradually impede the passage of nerves through the foramina or central canal, producing foraminal stenosis or central canal stenosis. This is accompanied by pain, especially with movement, as the vertebra will shift, causing pain and neurological impairment.

Symptoms and diagnosis

The symptoms, although variable, will depend on the segment affected by the displacement because it will involve neurological involvement. It is also accompanied by pain, leg weakness, and an inability to walk for long periods of time, requiring a few minutes of rest before resuming walking.

Although the diagnosis may be simple, under the evaluation of an experienced radiologist or traumatologist, it can be suspected and diagnosed with X-rays, and they are even recommended to assess the degree of instability of the displaced segment.

The diagnostic test of choice is magnetic resonance imaging, as it allows us to confirm whether the rest of the joint is affected, allowing for a precise assessment of neurological, disc, and muscular tissue.

Electromyography may also be recommended to assess whether there is significant neurological involvement and avoid wasting time before offering treatment.

What is the treatment for spondylolisthesis?

Initially, conservative treatment can be useful, especially if combined with a lumbar support with posterior reinforcement (in the case of lumbar pain) and a neck brace (in the case of cervical pain), ensuring the stability of the segment and ensuring there is no associated neurological injury.

It is treated with anti-inflammatories, muscle relaxants, and rest. When initial treatment has not been optimal, or the segment presents significant instability, the treatment is surgical and aims to correct and stabilize the vertebra, thereby protecting the neurological structures.

The possibilities of surgical treatment must be discussed with the surgeon, who will understand each patient's needs and will try to correct the instability while ensuring that the nerves and adjacent discs remain in the best possible condition.