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1. What is spondylolisthesis?
What is spondylolisthesis? |
Anterior spondylolisthesis is a disease in which the upper and lower vertebrae do not connect normally and are out of alignment due to a misalignment of the bones. It usually occurs in the lumbar vertebrae, towards the 4th and 5th vertebrae, but it can occur in any part of the spine. It is caused by repeated degeneration over a long period of time.
MRI or X-rays show that the vertebrae are not connected in a straight line, but are pushed out.
When spondylolisthesis occurs, all spinal disorders such as spinal stenosis, disc, foramen stenosis, and instability can occur at the same time.
Once the spine narrows due to stenosis, it is very difficult for it to widen naturally. Once it goes wrong, it cannot be resolved with any medicine, and it can only be treated with surgery.
Spondylolisthesis is dangerous because the vertebrae are misaligned, so even a brief moment can cause paralysis, and it originates from the fifth nerve in the spine, which is located below the vertebrae and can affect the ankle. It also occurs in women because after menopause, female hormones plummet, resulting in a decrease in muscle mass and weakened bones.
Why does spondylolisthesis occur?
The causes of spondylolisthesis can be broadly divided into three main types: degenerative, detached, and traumatic.
First, degenerative
It is the main trigger of spondylolisthesis.
Second, severability
This is when a defect in the isthmus of the spine causes spondylolisthesis. Also called 'spondylolisthesis', it most commonly occurs in the lumbosacral region, which is usually the upper part of the buttocks.
Third, traumatic
This is the case when an injury is caused by an external impact and a compression fracture occurs.
Degenerative and detachable spondylolisthesis is a common and slow-progressing degenerative disease. However, in the case of traumatic symptoms, the spine can quickly become severely deviated and can lead to quadriplegia, which can be accompanied by very severe sequelae.
Why is spondylolisthesis accompanied by stenosis?
When spondylolisthesis occurs, it is often accompanied by spinal canal/foramen stenosis. The cause of spinal canal/foramen stenosis is also spinal overuse and aging, and it is a disease that causes back pain due to narrowing of the intervertebral foramen in the middle of the spine.
When the spondylolisthesis occurs, the disc is pushed out as the spine is misaligned, and when the damage is repeated and pushed further and further, the surrounding ligaments and joints thicken due to the inflammatory reaction, resulting in stenosis that causes the disc to swell. This phenomenon causes you to feel back pain.
How is spondylolisthesis treated?
The treatment of spondylolisthesis is the same as the usual treatment for stenosis. If anterior dislocation is diagnosed, sufficient conservative treatment such as drug prescription and Prolo injection is first performed, followed by surgical treatment if necessary. Procedures such as nerve blocks and epidural catheterization may be performed before surgical treatment. If there is no remission afterwards, surgical treatment of fusion (fixation) or endoscopic decompression is performed. Which of the two surgeries to undergo depends on whether or not spinal instability is present.
If you have spinal instability*, you will need to perform immobilization* because it will require a firm fixation, and if you do not have instability, you may only need decompression*. The advantage of decompression surgery is that it minimizes muscle and ligament damage, so only the compressed part can be removed while saving the core. In advanced age or conditions where fusion is difficult, partial decompression surgery can be performed to control pain with minimal decompression.
In recent years, the trend has been to avoid incisions as much as possible. This is because incision not only damages the erector muscle, but also decompression alone aggravates spinal misalignment. Therefore, open surgery does not go well in spinal surgery. In general, non-surgical treatments such as injections and procedures are performed first, followed by fixation surgery, which involves firmly screwing in the screws.
How is spondylolisthesis prevented?
The basic principle for the prevention of spondylolisthesis is that spinal stability is important. There are three things that determine spinal stability:
First, erector spinae muscle
It is recommended to proceed with the three core exercises: squats, lunges, and planks.
Second, a healthy disc
Avoiding a sedentary lifestyle and getting up once in a while to stretch when working for a long time is very helpful.
Third, adequate lordosis of the spine
It is recommended to maintain a lordosis angle that is appropriate for the shape of the individual spine.
It's important to prevent bad habits and posture in your daily routine and take care of them consistently. Even when doing exercises such as planks, you need to keep your lordosis angle, and if you find it difficult, you can do it on your knees. In addition, it may be helpful to strengthen your stomach and take a half-body bath frequently to loosen stiff muscles.
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