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Spondylolisthesis - A disease of the spine, where a person is displaced vertebra forward or backward relative to other vertebrae. Defined concepts anterolistez (vertebra shifts forward) and retrolisthesis (vertebra moves back).
The consequence of displacement of the vertebrae can become a serious spinal deformity, narrowing the spinal canal and compression of the nerve roots that emerge from the intervertebral holes (the so-called foraminal stenosis ).
Reasons spondylolisthesis
Thus, spondylolisthesis - this displacement of the vertebrae relative underlying vertebra. In most patients diagnosed offset at 5 vertebra, and 4 vertebra. Less commonly diagnosed displacement of the thoracic vertebrae.
The main reason is the displacement of the vertebrae spondyloschisis . This term defines a defect of one of the vertebrae, located in the lumbar spine. With the development of this disease in a patient comes fractured vertebra legs. Leg vertebra - is education, which is connected to the body of the vertebra and the facet joints. If a person develops spondylolysis, the rear part of the vertebra with vertebral body is connected only with the help of scar tissue. Typically, this condition develops as acquired diseases. Fracture feet vertebrae in humans occurs in childhood. The main reasons for this are taken by some sports. This fracture never heals completely, and later had symptoms develop spondylolisthesis.
With the development of spondylolysis facet joints are not able to keep the vertebrae, so he moves. As a consequence, there is a gradual extension of the intervertebral disc with loads and vertebrae lying above slides. In most cases, the vertebrae of the lumbar and thoracic spine slide slow, so for a few years, the treatment of the disease is not practiced. But over time the disease progresses, and the person has developed low back pain. Pain usually begin to seriously disturb the person after 35 years of age.
Experts identify certain risk factors for this disease. First of all, spinal disease in relatives, stretching the spine, or the occurrence of repeated injuries. The risk of developing spondylolisthesis and athletes whose spines are subjected to tension. It weightlifters, gymnasts, rugby players and others.
Types of spondylolisthesis
There are five types of spondylolisthesis of the lumbar spine. Dysplastic spondylolisthesis It is a congenital disease. It occurs when there is some malformation of the vertebrae, due to which he moves.
With isthmic spondylolisthesis there is a defect in the vertebra interarticular surface. In the absence of bias and the presence of such a defect is established patient diagnosis "spondylolysis". This form of spondylolisthesis cause repetitive trauma, so often isthmic spondylolisthesis occurs in people who are actively involved in sports.
Degenerative spondylolisthesis a person develops as a consequence of the nature of arthritic changes in the joints of the vertebrae. This phenomenon occurs because of degeneration of the cartilage. This form of the disease is often diagnosed in older people.
Traumatic spondylolisthesis - A consequence of direct trauma, as well as damage to the vertebrae. The disease develops as a result of breaking the legs, the facet joint, vertebra plate arc. As a result, the front part moves forward.
Pathological spondylolisthesis - A consequence of a defect in the bone, which appears under the influence of the tumor.
Symptoms of spondylolisthesis
The main symptom of spondylolisthesis is a pain that becomes chronic. But experts note that back pain is exacerbated not all patients with spondylolisthesis. Just in the development of this phenomenon in humans increases the risk of chronic pain in the back. In this disease can develop a mechanical pain and radicular pain. Mechanical pain It manifested due to the instability of the vertebral-motor segment due to the slipping vertebra. Occurrence radicular pain - A consequence of compression of the nerve root ligaments and bones. Nerve root can also be squeezed by scar tissue that forms in the place where there was a crisis.
By moving forward overlying vertebra can develop spinal stenosis .
Usually pain in spondylolisthesis occur in the lower back, while giving the pain in the buttocks. Often, the pain becomes stronger when one extends the lower back. If the compressed nerve root, the evident pain in the legs, sometimes accompanied by weakness and numbness.
Offset lumbar spine is divided into four stages. In first stage people rarely show feels pain. In second stage the displacement of the vertebrae vertebrate already causing more severe pain and discomfort during movement. In third step symptoms of the disease not only pain, but also the subsidence of the spine. Most pronounced in the displacement of the vertebrae a fourth step When a person has developed a characteristic gait. Treatment in this case the least effective.
Cervical dislocation leads to the manifestation of pain in the neck. This diagnosis can have negative consequences, so its treatment should be done only under the supervision of a specialist. Symptoms of severe displacement of the cervical vertebrae can manifest dysfunction of the upper extremities.
Complications
As complications of the disease can develop chronic pain in the lower back or legs, as well as a manifestation of weakness, or numbness in the extremities. If the nerves are compressed very strongly, the patient may lose control over the bladder or bowel. However, such manifestations of spondylolisthesis occur relatively rarely.
Diagnostics
Prior to the research physician is necessary to conduct a detailed survey of the patient's medical history and examine. It is necessary to learn about the pain manifested itself for the first time, what is its character, whether manifested numbness and weakness of the legs. A specialist must perform a physical examination. This inspection and palpation of the area where the pain appears, check the tendon reflexes, muscle strength determination, the sensitivity of the skin, the tension of the nerve roots.
Diagnose the disease by using the information obtained in the process rengenografii and computer tomography or MRI . However, most patients already diagnosed disease can be via radiography. But if the patient has been diagnosed with "spondylolisthesis," it does not mean that this disease is the cause of pain in the back. Generally, a specialist should eliminate a number of other diseases, for example, disc herniation And only after it determines whether the pain with spondylolisthesis.
Depending on the intensity of the displacement of the vertebrae are five degrees of spondylolisthesis. If the first degree, a shift of no more than 25%, the fifth degree spondylolisthesis diagnosed when a vertebra is completely separated from the adjoining vertebra.
Treatment
Spondylolisthesis spine that affects the thoracic, lumbar and cervical, is treated by both conservative and surgical methods. Conservative treatment of spondylolisthesis is conducted by the same methods as the treatment of pain in the spine instability. The main objective in this case - to strengthen the muscles of the back and abdominal muscles to prevent movement and reduce the severity of vertebral spine instability. When expressed pain syndrome, prescribers who cropped and reduce pain spasm paravertebral muscles . If the patient complains sharp pain Then for a while it is assigned to wear a special corset. But you can not wear a corset for a long time, since it increases the instability of the spine. Practitioners also special exercises that are performing at long can reduce the symptoms of spondylolisthesis.
Sometimes the symptoms of the disease facilitates the prohibition of certain types of physical activity - a sharp stooping, lifting, active sports exercise.
Sometimes severe pain practiced epidural injection Steroid ( Cortisone ).
Operation is assigned if conservative therapy is ineffective. Surgery is carried out to stabilize the spine and reduce the compression of nerve structures. Mainly as a laminectomy surgery is performed, that is, the removal of the vertebral arch. Specialist removes excess scar tissue where developed spondylolysis. As a result, stops compression of the nerve roots. After that the stabilization of the spine to reduce the instability of the vertebral-motor segment.
Today, there are also new methods of surgical treatment of spondylolisthesis. One of them is to connect displaced vertebrae special screws and attached to the metal structure. Such operations are also carried out at scoliosis and other diseases.
Experts say a good prognosis in spondylolisthesis. In most cases, effectively acts conservative therapy.
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