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Backbone. Shift of vertebrae (spondylolisthesis)
The spondylolisthesis is an illness of a backbone at which the person has a dislocation of the vertebra forward or back concerning other vertebrae. Concepts anterolistez (the vertebra is displaced forward) and retrolistez are defined (the vertebra is displaced back).
Serious deformation of a backbone, narrowing of the channel of a backbone, and also squeezing of roots of nerves which come out intervertebral foramens (a so-called foraminalny stenosis) can become an effect of shift of vertebrae.
Thus, the spondylolisthesis is the shift of vertebrae on the relation of an underlying vertebra. Most often shift at the level of 5 vertebra, and also 4 vertebras is diagnosed for patients. Shift of chest vertebrae is less often diagnosed.
The spondylosis is a basic reason of shift of vertebrae. Determine by this term existence of defect of one of the vertebrae located in lumbar department of a backbone. At development of this illness in the patient there is a vertebra leg fracture. The leg of a vertebra is an education by means of which the body of a vertebra and facet joints connects. If at the person the spondylosis develops, then the back part of a vertebra with a body of a vertebra connects only to the help of cicatricial fabric. As a rule, such state develops as an acquired disease. The vertebra leg fracture at the person occurs in the childhood. Generally occupations by some sports become the reason of it. Such change never grows together completely, and later at the patient spondylolisthesis symptoms begin to develop.
At development of a spondylosis facet joints are not capable to hold a vertebra therefore it is displaced. As a result, there is a gradual extension of an intervertebral disk at loadings, and the vertebra lying above slides off. In most cases vertebrae of lumbar and chest department of a backbone slide off slowly therefore throughout several years treatment of an illness does not practice. But over time the disease progresses, and at the person pain in the bottom of a back already develops. Pain, as a rule, begins to disturb seriously the person after 35-year age.
Specialists define some risk factors of development of this disease. First of all, it is spinal diseases at relatives, developing of stretching of a backbone or repeated injuries. Also athletes at whom backbones are exposed to stretching risk to get sick with a spondylolisthesis. These are weight-lifters, gymnasts, rugby players, etc.
Types of a spondylolisthesis
Five kinds of a spondylolisthesis of lumbar department of a backbone are allocated. The dysplastic spondylolisthesis is an inborn illness. It develops if there is a certain malformation of a vertebra because of which that is displaced.
At an isthmic spondylolisthesis there is a defect at an interarticular surface of a vertebra. In the absence of shift and existence of such defect to the patient the diagnosis "spondylosis" is established. This form of a spondylolisthesis is caused by repeated injuries therefore often isthmic spondylolisthesis develops at the people who are actively playing sports.
The degenerative spondylolisthesis at the person develops as an effect of changes of arthritic character in joints of vertebrae. This phenomenon arises because of a cartilage degeneration. This form of an illness is often diagnosed for elderly people.
Traumatic spondylolisthesis – an effect of direct injuries, and also injuries of vertebras. The illness develops owing to a fracture of a leg, a facet joint, a vertebra arch plate. As a result of its the front part is displaced forward.
Pathological spondylolisthesis – an effect of emergence of defect in a bone which appears under the influence of a tumor.
The main symptom of a spondylolisthesis is the back pain which gains chronic character. But specialists note that the dorsodynia becomes aggravated not at all patients with a spondylolisthesis. Just at development of this phenomenon in the person the risk of emergence of a chronic pain syndrome increases in spin. At this disease pain of mechanical character, and also radicular pains can develop. Mechanical pain is shown owing to instability of a pozvonkovo-motive segment because of sliding of a vertebra. Developing of radicular pain – a consequence of squeezing of a nervous root ligaments and bones. The nervous root can be also squeezed by cicatricial fabric which is formed in that place where there was a change.
At anteposition of an overlying vertebra the stenosis of the vertebral channel can develop.
As a rule, pain at a spondylolisthesis is shown in a lower back, at the same time pain gives to the area of buttocks. Often pain becomes more severe when the person unbends a waist. If the nervous root is squeezed, then the onychalgia which sometimes is followed by weakness and numbness of an extremity is shown.
Shift of vertebrae of lumbar department is subdivided into four stages. At the first stage of people feels seldom shown back pains. At the second stage the shift of vertebral vertebrae already causes more expressed pains and discomfort at the movements. At the third stage of a disease symptoms are shown not only pain, but also a backbone flash. Shift of vertebrae at the fourth stage when at the person characteristic gait already develops is most expressed. Treatment in this case is least effective.
Shift of cervical vertebrae leads to display of pain in a neck. This diagnosis can have negative effects therefore its treatment needs to be carried out only under supervision of the specialist. Symptoms of heavy shift of vertebrae of cervical department can be shown by disturbance of functions of upper extremities.
As complications of a disease the chronic pain syndrome in a lower part of a back or in legs, and also manifestation of numbness or weakness in extremities can develop. If nerves are squeezed very strongly, then the patient can lose control over work of a bladder or intestines. However such manifestations at a spondylolisthesis are observed rather seldom.
Before carrying out researches the doctor needs to conduct detailed survey of the patient and to study a case history. It is necessary to learn about when pain was shown for the first time what its character, whether is shown numbness and weakness of legs. The specialist surely conducts physical research. It is survey and a palpation of areas where morbidity, check of tendon jerks, determination of force of muscles, sensitivity of skin, a tension of nervous roots is shown.
It is possible to diagnose a disease by means of information obtained in the course of a X-ray analysis, and also a computer tomography or MRT. But it is possible to diagnose a disease for most of patients already by means of a X-ray analysis. But if the diagnosis "spondylolisthesis" was established to the patient, then it does not mean that this illness and is the reason of pain in spin. As a rule, the specialist has to exclude some other diseases, for example, disk hernias, and only after that establish whether pain is connected with a spondylolisthesis.
Depending on intensity of a dislocation of the vertebra five degrees of a spondylolisthesis are allocated. If at the first degree the shift which is not exceeding 25% is observed, then the fifth degree of a spondylolisthesis is diagnosed if the vertebra completely separates from the vertebra, next to it.
The spondylolisthesis of a backbone which strikes chest, lumbar and cervical departments is treated by both a conservative, and surgical method. Conservative treatment of a spondylolisthesis is carried out by the same methods, as therapy of pain at instability of a backbone. The main objective at the same time – to strengthen muscles of a back and a prelum abdominale to prevent a dislocation of the vertebra and to reduce expressiveness of instability of a backbone. If the pain syndrome is expressed, drugs which stop pain are appointed and reduce a spasm of paravertebral muscles. If the patient complains of an acute pain, then carrying a special corset is appointed to some time to him. But it is impossible to carry such corset throughout a long time as it increases instability of a backbone. Also special exercises which at long performance allow to reduce spondylolisthesis symptoms practice.
Sometimes symptoms of an illness are facilitated by prohibition of some types of physical activity – sharp stooping, a raising of weights, active sports exercises.
Sometimes at strong pain carrying out an epidural injection of a steroid (cortisone) practices.
Operation is appointed if conservative therapy is inefficient. Surgical intervention is carried out for the purpose of stabilization of a backbone and reduction of squeezing of structure of nerves. Generally as an operative measure the laminectomy, that is removal of a handle of a vertebra is carried out. The specialist deletes excess cicatricial fabric where the spondylosis developed. As a result, squeezing of nervous roots stops. After that stabilization of a backbone is carried out to reduce instability of a vertebral and motive segment.
Today there are also new methods of operational treatment of a spondylolisthesis. One of them consists in connecting the displaced vertebrae special screws and to attach to a design from metal. Such operations are also performed at scoliosis and other diseases.
Specialists speak about the good forecast at a spondylolisthesis. In most cases effectively conservative therapy works.
Section: Orthopedics and traumatology