Spondylolisthesis
Introduction
Introduction to lumbar spondylolisthesis Lumbar spondylolisthesis is caused by congenital dysplasia, trauma, strain and other causes of abnormal osseous connection of adjacent vertebral bodies. Partial or total vertebral body vertebral body and partial vertebral body slip. Normal people's lumbar vertebrae are neatly arranged. If one of the lumbar vertebrae slides forward relative to the adjacent lumbar vertebrae due to congenital or acquired causes, it is lumbar spondylolisthesis. The lumbar isthmus refers to the narrow part between the superior and inferior articular processes, where the bone structure is relatively weak. The normal lumbar spine has a physiological lordosis, the atlas is a physiological kyphosis, and the junction of the lumbar and atlas is a turning point. Lumbar spondylolisthesis below I degree can be treated conservatively, including bed rest, back muscle exercise, waist circumference or brace; appropriate aerobic exercise can be used to reduce weight; activities to increase waist load, such as lifting weights, are prohibited. Bend and other; in addition to physical therapy such as infrared, hyperthermia; if there are symptoms such as pain, oral anti-inflammatory painkillers such as Celebrex, Fenbid and other symptomatic treatment. basic knowledge The proportion of illness: 0.02% Susceptible people: no special people Mode of infection: non-infectious Complications: shock, atelectasis, urinary tract infection
Cause
Causes of lumbar spondylolisthesis
Trauma factor (20%):
Acute trauma, extensor trauma, acute fractures can lead to lumbar spondylolisthesis, which is more common in carrying heavy loads, weightlifting, football, sports training, trauma, wear and tear.
Degenerative factors (20%):
Due to long-term sustained lower back instability or increased stress, the corresponding small joints wear, degenerative changes occur, joints are abruptly leveled, and intervertebral disc degeneration, intervertebral instability, anterior ligament slack, and gradually slip, but the isthmus Still intact, also known as pseudo-slip, usually occurs after the age of 50, this slip is usually accompanied by lumbar spinal stenosis, experts in the annual orthopaedic hospital say that more surgery is needed.
Pathological fractures (15%):
Mostly due to systemic or local tumors or inflammatory lesions, involving the vertebral arch, isthmus, and articular processes, the structural stability of the vertebral body is lost, and pathological spondylolisthesis occurs.
Fatigue fracture or chronic strain (15%):
When the human body is standing, the weight of the lower lumbar spine is large, which causes the component force of the forward movement to act on the isthmus with relatively weak bone. Long-term repeated action can lead to fatigue fracture and chronic strain damage.
Congenital dysplasia (10%):
The lumbar vertebrae have vertebral body and vertebral arch ossification center. Each vertebral arch has two ossification centers, one of which develops as superior articular process and pedicle, and the other develops into lower articular process, lamina and spinous process. Half of it, if there is no healing between the two, it will cause the congenital isthmus to collapse and cause lumbar spondylolisthesis. In addition, slippage may occur due to abnormal development of the upper part of the humerus or the L5 vertebral arch, but in this case, the isthmus does not collapse.
Prevention
Lumbar spondylolisthesis prevention
1, strengthen the back muscle function exercise
The strength of the back muscles can increase the stability of the lumbar spine and antagonize the tendency of lumbar spondylolisthesis. There are two ways to exercise your lower back muscles. The first one is the prone position. The upper limbs are abducted, raised, raised, and the upper limbs leave the bed. At the same time, the lower limbs are also straight and raised upwards to form a swallow-like shape. The second is the supine position, the two knees are flexed, and the feet are stepped on the bed. When inhaling, the chest is quite waisted, so that the buttocks leave the bed and exhale.
2. Restricted activities
Reduce excessive rotation of the waist, pick up and other activities, reduce excessive weight on the waist. This can reduce excessive strain and degeneration of the lumbar facet joints, and to a certain extent avoid the occurrence of degenerative lumbar spondylolisthesis.
3, reduce weight
In particular, reduce abdominal fat accumulation. Excessive weight increases the burden and strain on the lumbar spine, especially the accumulation of abdominal fat, which increases the tendency of the lumbar spine to slip forward on the tibia.
Complication
Lumbar spondylolisthesis Complications, pulmonary atelectasis, urinary tract infection
Perioperative period may have shock, deep vein thrombosis, dyspnea, pulmonary infection and atelectasis, urinary tract infection, bloating and vomiting and other systemic complications.
Symptom
Lumbar spondylolisthesis symptoms Common symptoms Chronic low back pain with lower extremity numbness lower limbs induced pain or release... Lower extremity radiation pain incontinence
The clinical symptoms caused by lumbar spondylolisthesis are highly variable. Not all spondylolisthesis has clinical symptoms, and different patients may have different clinical symptoms and severity. This is in addition to the compensatory capacity of the structure around the spine, but also depends on the extent of secondary damage, such as joint hyperplasia, spinal stenosis, horsetail and nerve root compression.
The main symptoms include the following:
1. Pain in the lumbosacral region: more manifested as dull pain, a very small number of patients can have severe tail bone pain. Pain can occur after exertion or persist after a sprain. When standing, bending, it is aggravated, and it is relieved or disappeared after bed rest.
2. Sciatic nerve involvement: manifested as lower extremity radiation pain and numbness, which is due to the fibrous connective tissue or hyperplastic callus at the isthmus fracture can compress the nerve root, the nerve root is pulled when slipping; the straight leg elevation test is mostly positive.
3. Intermittent claudication: If the nerve is compressed or combined with lumbar spinal stenosis, intermittent claudication symptoms often occur.
4. The cauda equina is affected by tension or compression. When the slippage is severe, the cauda equina can be affected by weakness of the lower limbs, numbness in the saddle area, and dysfunction of the bowel and bladder.
5. Increased lumbar lordosis, kyphosis of the hips. Patients with severe slippage may have a lumbar depression, a bulge in the abdomen, and even a shortened trunk and a sway when walking.
6. Palpation slips off a spinous process forward, there is a sense of step in the back of the waist, spinous process tenderness.
Examine
Lumbar spondylolisthesis
First, the front and back X tablets
"It is not easy to display isthmus lesions. By careful observation, it may be found that there is a density of oblique or horizontal fissures under the shadow of the pedicle, mostly bilateral. In patients with obvious spondylolisthesis, the vertebral body is inclined and the lower edge is blurred.
Second, the lateral X film
Can clearly show the shape of the vertebral arch. The fissure is below the pedicle and there is often a sign of sclerosis between the superior and inferior articular processes. Lateral radiographs can show signs of lumbar spondylolisthesis and can measure slippage indexing. The Meyerding classification is commonly used in China, that is, the upper edge of the lower vertebral body is divided into 4 equal parts, and the degree of I-IV is divided according to the degree of forward vertebral body sliding relative to the lower vertebral body.
I: refers to the vertebral body sliding forward no more than 1/4 of the sagittal diameter of the vertebral body.
II: More than 1/4, but no more than 2/4.
III: More than 2/4, but no more than 3/4.
IV: 3/4 of the sagittal diameter of the vertebral body.
Third, oblique X film
The isthmus lesion can be clearly displayed. When the vertebral arch is cracked, a band-like fissure may occur in the isthmus, which is called the Scotty dog neck fracture sign.
Fourth, the power bit X piece
The activity of the slip can be judged, and the value of determining whether or not the lumbar instability is high is high. The X-ray diagnostic criteria for lumbar instability are over-extension, over-flexion, forward or backward displacement >3 mm or endplate angle change >15°.
Five, lumbar CT
The CT findings of lumbar spondylolisthesis are mainly: 1 bilateral sign 2 double tube sign 3 intervertebral disc deformation, ie the deformation of the annulus at the level of slippage, showing a symmetrical soft tissue shadow on the posterior border of the anterior vertebral body, and the posterior lower edge of the next vertebral body No intervertebral disc tissue. The 4 isthmus crack appears in the plane of the lower edge of the pedicle, and the direction of travel is indefinite, and the edge is jagged. Three-dimensional CT or sagittal multiple reconstruction can determine the degree of intervertebral foramen and the degree of slippage.
Six, lumbar magnetic resonance
Magnetic resonance imaging (MRI) can observe the compression of the lumbar nerve roots and the degree of degeneration of each intervertebral disc, which helps to determine the extent of decompression and fusion.
Diagnosis
Diagnosis and diagnosis of lumbar spondylolisthesis
diagnosis
Diagnosis can be made based on medical history, clinical manifestations, and examination.
Differential diagnosis
First, congenital spondylolisthesis
The congenital isthmus is stunted and cannot support the gravity of the upper part of the body, and is often accompanied by L5S1 spina bifida.
Second, isthmic spondylolisthesis
The structure of the posterior vertebral body is basically normal, and the spondylolisthesis caused by the abnormal isthmus. Divided into two types: a isthmus separation: isthmic fatigue fracture; b isthmus only elongated without breaking, still maintain continuity.
Third, degenerative spondylolisthesis
Caused by degeneration of the intervertebral disc, more common in the elderly.
Fourth, post-traumatic slippage
Severe acute injury to the bony area of the pedicle with pedicle fracture.
Fifth, pathological slippage
Secondary to systemic disease, leading to facet joint fracture or elongation.
Sixth, iatrogenic spondylolisthesis
More common after surgical treatment, caused by extensive laminectomy and facet joint decompression.
