What is a spondylolisthesis?
Spondylolisthesis is a disease caused by the loss of stability between the vertebrae, most frequently in the lumbar region. The spine’s vertebrae are stacked, one on top of the other. The ligaments and joints that join them allow their mobility within limits, maintaining their alignment and stability. When these structures lose their integrity, the vertebrae shift, characteristically sliding over each other, causing the symptoms of the disease to a greater or lesser extent.
Spondylolisthesis is due to degenerative causes in the context of degenerative spondylotic lumbar disease. Still, it can also be present in young people, where a stress fracture of the articular isthmus typically occurs or due to congenital causes.
We classify it into degrees (I to IV) depending on the intensity of the slip (%), and grade V spondylolisthesis or spondyloptosis is called the exceptional case in which one vertebra is completely displaced on another, having lost all the structural support of the spine.
How is spondylolisthesis diagnosed?
The most common symptom of a patient with spondylolisthesis is low back pain of greater or lesser intensity, generally associated with physical exertion or specific postures where instability is accentuated. They may also report sciatic pain since vertebral displacement reduces the caliber of the lumbar canal and the exit foramina of the nerve roots. In the most severe cases, the extremities’ loss of strength or sensitivity may appear or cause sexual and sphincter functional alterations.
Magnetic resonance imaging and computed tomography are the main tests to confirm the diagnosis, its location, and severity. Electromyography is a diagnostic test that can provide valuable insights into the extent of neurological damage.
What is the treatment of spondylolisthesis?
It’s important to understand that the process is often a prolonged evolution over time, with acute presentation being rare.It’s important to understand that acute changes are rare; evolution takes time. Patients with different degrees of clinical involvement may initially manage symptoms conservatively, through rehabilitation reinforcing the lumbar and abdominal muscles, and occasionally taking analgesics or using an orthopedic girdle.
Surgical treatment is considered if the condition progresses and the symptoms become more limiting or in young patients who demand a complete normalization of their activity. This has two pillars: decompression of the compressed nerve structures and stabilizing the unstable segment or segments. This requires performing instrumentation or arthrodesis using different techniques depending on the case to regain the spine’s stability.
