Diagnosis and conservative management of degenerative lumbar spondylolisthesis

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Degenerative Spondylolisthesis | Spine-health

Degenerative spondylolisthesis is Latin for “slipped vertebral body,” and it is diagnosed when one vertebra slips forward over the one below it. This condition occurs as a consequence of the general aging process in which the bones, joints, and ligaments in the spine become weak and less able to hold the spinal column in alignment.

Watch: Degenerative Spondylolisthesis Video

Degenerative spondylolisthesis is more common in people over age 50, and far more common in individuals older than 65. It is also more common in females than males by a 3:1 margin.

A degenerative spondylolisthesis typically occurs at one of two levels of the lumbar spine:

• The L4-L5 level of the lower spine (most common location)
• The L3-L4 level.

Treatment for Spondylolisthesis Video

Degenerative spondylolisthesis is relatively rare at other levels of the spine, but may occur at two levels or even three levels simultaneously.
While not as common as lumbar spondylolisthesis, cervical spondylolisthesis (in the neck) can occur. When degenerative spondylolisthesis does occur in the neck, it is usually a secondary issue to arthritis in the facet joints.

This article reviews the underlying causes, diagnosis, symptoms, and full range of surgical and non-surgical treatment options for degenerative spondylolisthesis.

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Degenerative Spondylolisthesis Causes

Every level of the spine is composed of a disc in the front and paired facet joints in the back. The disc acts as a shock absorber in between the vertebrae, whereas the paired facet joints restrain motion. They allow the spine to bend forwards (flexion) and backwards (extension) but do not allow for a lot of rotation.

As the facet joints age, they can become incompetent and allow too much flexion, allowing one vertebral body to slip forward on the other.

In This Article:

• Degenerative Spondylolisthesis

• Degenerative Spondylolisthesis Symptoms

• Degenerative Spondylolisthesis Treatment

• Surgery for Degenerative Spondylolisthesis

• Degenerative Spondylolisthesis Video

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Degenerative Spondylolisthesis Diagnosis

Degenerative spondylolisthesis is diagnosed by a spine specialist through a 3-step process:

• Medical History – primarily a review of the patient’s symptoms and what makes the symptoms better or worse.
• Physical Examination – the patient is examined for physical symptoms, such as range of motion, flexibility, any muscle weakness or neurological symptoms.
• Diagnostic Tests – if a spondylolisthesis is suspected after the medical history and physical exam, an X-ray may be done to confirm the diagnosis and/or rule out other possible causes of the patient’s symptoms. Based on the results of the X-ray, further tests may be ordered, such as an MRI scan, to gain additional insights.

More Spondylolisthesis Info:

Isthmic Spondylolisthesis

Spondylolysis

Spondylolysis Treatment

Spondylolisthesis Symptoms and Causes Video

Unlike Isthmic Spondylolisthesis, the degree of the slip of a degenerative spondylolisthesis is typically not graded as it is almost always a grade 1 or 2.

In cases of degenerative spondylolisthesis, the degenerated facet joints tend to increase in size, and enlarged facet joints then encroach upon the spinal canal that runs down the middle of the spinal column, causing lumbar spinal stenosis.

Dr. Peter Ullrich is an orthopedic surgeon who retired from practice with more than 20 years of experience specializing in spine surgery. Dr. Ullrich previously practiced as an orthopedic spine surgeon at the NeuroSpine Center of Wisconsin.

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Editor’s Top Picks

• Isthmic Spondylolisthesis

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• Facet Joint Osteoarthritis

• Degenerative Spondylolisthesis Video

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Spondylosis of the lumbar spine – symptoms, causes, treatment

This disease is treated by a neurologist.

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Spinal spondylosis is a chronic disease resulting from degenerative-dystrophic processes of the fibrous ring of the intervertebral disc. Spondylosis is one of the types of osteopathies – diseases grouped according to common characteristic features: dystrophy of the structures of the spine, pain syndrome, limitation of mobility. It affects all parts of the spinal column, but most often the lumbosacral.

CMRT specialist tells

Kuchenkov A.V.

Orthopedist • Traumatologist • Surgeon • Phlebologist • Sports doctor • 24 years of experience

Publication date: May 18, 2021

Verification date: January 10, 2023

All facts have been verified by a doctor.

Contents of the article

Causes of spondylosis

Symptoms of spondylosis of the lumbosacral spine

The initial stage of the disease is characterized by a latent course. As the pathological process progresses, symptoms appear:

• Limited mobility in the lumbar spine.
• Unpleasant sensations in the buttocks and thighs after prolonged exertion on the legs
• Back pain after prolonged static posture

Deforming spondylosis of the lumbar spine gives the following symptoms:

• Lumbar pain when turning the body, when walking down stairs
• Lameness when pain radiates to the lower extremities

Antespondylolisthesis (displacement of the vertebrae relative to each other) causes pinching of the nerves of the “cauda equina”, which is located in the lower parts of the spinal cord. In the clinical picture, neurological symptoms come to the fore:

• Severe pain in the perineum, in the legs
• Development of paresthesia – a feeling of numbness, tingling, burning below the level of damage to the spinal segment: lower back, buttocks, legs
• Increasing muscle weakness lower limbs
• Disorder of the pelvic organs: violation of the process of urination, defecation

Stages of development of spondylosis

The process of degenerative changes in intervertebral discs with the formation of osteophytes successively goes through several stages:

I stage. There are initial changes in the fibrous tissues of the intervertebral disc: cracks, fractures, decreased elasticity. Single spiny bone growths (osteophytes) do not extend beyond the vertebral bodies. Symptoms characteristic of spondylosis of the lumbosacral spine are absent, the patient may sometimes be bothered by minor pain in the lumbar region.

Stage II. Active proliferation of osteophytes continues. Mobility in the damaged spinal segment decreases, pains join, the intensity of which increases with physical exertion, hypothermia.

Stage III . Complete destruction of cartilage. Bone growths, increasing in size, merge into rough osteophyte complexes connecting two or more vertebrae. This disrupts the normal mobility of the lumbar spine. When osteophytes compress the nerve roots of the spinal cord, neurological disorders develop, aggravated by a severe pain syndrome. 9How to diagnose? x, CT, MRI can detect pathological changes in bone, cartilage, soft tissues in the early stages.

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How to treat spondylosis

Rehabilitation after spondylosis

Consequences

Prevention

Treatment and rehabilitation for spondylosis in CMRT clinics

Spondylosis lumbosacral spine, symptoms, causes and treatment

Lumbar spondylosis spine – a disease that is characterized by damage to the joints of the lower back, the growth of osteophytes. Bone formations appear mainly along the anterior edge of the vertebrae, and the lateral regions are also affected. The pathological process is associated with excessive loads, unsatisfactory physical condition of a person. In parallel with this, muscle spasm is observed, which limits mobility in the lumbosacral region. If there is no adequate treatment, then the bone growths become larger, infringe on the nerve roots and spinal cord.

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact a specialist.

Symptoms of the disease, signs

The initial stage of lumbar spondylosis proceeds almost imperceptibly. In the modern rhythm of life, many people do not pay attention to the slight stiffness in movement. The further the disease develops, the more noticeable the symptoms become:

• soreness in the loins, buttocks and legs;
• lameness, intense discomfort in calf muscles;
• inability to fully bend over.

The pain gets worse in the evening, and also when trying to move more or less actively. Often a person has to take forced postures. At 2-3 stages progress:

• paresthesia;
• loss of sensitivity of the skin of the buttocks;
• Difficulty in movements of the knee joints, leg abduction in the hip joints.

With an increase in the duration of the disease, the symptoms of spondylosis of the lumbosacral spine become more acute and interfere with a normal lifestyle. In some cases, the signs of pathology intensify when the weather changes.

It is important to distinguish osteochondrosis from spondylosis. With osteochondrosis, pain with pressure on the spinous processes is not noted. And for spondylosis, this is a characteristic manifestation. When it affects the lumbosacral spine, predominantly L3-L5 suffer. Osteochondrosis in most cases affects the L5-S1 vertebrae.

Causes of lumbar spondylosis

Pathological growth of bone tissue is caused by degenerative changes that lead to a deterioration in the mobility of the spinal column. They are provoked by:

• direct and indirect injuries of the local muscle-ligament apparatus;
• prolonged stay in a physiologically incorrect position;
• dynamic loads on the muscles with obvious hypodynamia;
• infectious lesions;
• neoplasms;
• genetic predisposition;
• overweight.

Cause the development of spondylosis age-related changes in the tissues of the spine, as well as constitutional predisposition. Abnormal growth of the bone structure can be observed under the influence of oncological diseases. Both hypo- and hyperdynamia pose a certain health hazard.

Effective treatments

The prescribed therapy should take into account the special properties of the human body. Treatment methods for lumbar spondylosis are aimed at: restoring a full blood supply; improvement of the condition of cartilage tissue; elimination of pain; strengthening muscles and ligaments.

Therapy includes pharmacological and non-pharmacological methods. Among medicines positive effect is exerted by:

• NSAIDs;
• muscle relaxants;
• preparations of natural cartilage tissue components.

If the lumbar region is affected, spondylosis responds well to physiotherapeutic methods:

• acupuncture;
• ultrasound;
• paraffin packs;
• manual therapy;
• massage.

After relief of acute pain, exercise therapy is started. Therapeutic gymnastics has a restorative and healing effect.

What if the disease is not treated?!

With timely diagnosis and treatment, the prognosis is quite favorable. However, attempts to independently stop the pain syndrome or ignore the symptoms lead to the progression of the pathology. Over time:

• limbs become numb;
• mobility is sharply limited;
• muscles atrophy;
• partial or complete immobilization occurs.

Lumbar spondylosis responds well to treatment.