What Is Isthmic 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, and the sacrum is physiologically kyphosis. The upper lumbar spine is tilted forward, and the lower sacrum is tilted backward. Therefore, the negative gravity of the lumbar and sacral spine naturally forms a forward component, causing the waist 5 to slide forward. Under normal circumstances, the force of the lower 5 joints of the waist and the surrounding joint capsules and ligaments can limit this slip tendency, so that the lumbar 5 isthmus is at the intersection of the two forces, so the isthmus is prone to collapse, which is also the most of the waist 5 isthmus. reason.

Basic Information

Visiting department: orthopedics
Common locations: Lumbar spine

Common causes: Congenital spondylolisthesis, trauma, strain
Common symptoms: Lower back pain, radiation pain

Causes of lumbar spondylolisthesis and lumbar spondylolisthesis

Causes include congenital lumbar spondylolisthesis, which can also be caused by trauma and strain. The real cause of lumbar isthmus fracture is still uncertain. Many studies have been conducted over the years, and congenital developmental defects and chronic strain or stress injuries have been found to be two possible important causes.

Clinical manifestations of lumbar spondylolisthesis and lumbar spondylolisthesis

Symptoms

Early lumbar spondylolisthesis and lumbar spondylolisthesis may not be symptomatic. Some patients may have sore lower back pain, most of which are milder, often worsening after exertion, and may also begin with mild trauma. After taking a proper rest or taking painkillers, there are many improvements, so the medical history is longer. Low back pain is intermittent in the beginning, but it can be persistent in the future. In severe cases, it affects normal life and cannot be relieved by rest. Pain can radiate to the crotch, hips, or back of thighs at the same time. If combined with lumbar disc herniation, it can manifest as symptoms of sciatica.

2. Signs

Usually there are not many signs. Those who simply collapse the isthmus without slippage can be found without any abnormalities. During the physical examination, there was only slight tenderness at the spinous process, between spines, or next to the spinous processes. Waist movement can be unrestricted or slightly restricted. There were no abnormal objective signs on the tail and hips.

Patients with lumbar spondylolisthesis may have the special appearance of lumbar forward protrusion, hip kyphosis, abdomen droop, and waist shortening. At this time, the spinous process of the diseased vertebra is posterior, and the spinous process above it is moved forward. On a plane. There may be a feeling of depression locally, and the posterior process of the sacrum increases. Pain between the spinous processes of the lumbosacral spine and the dorsal extensor tend to be tense. Waist movements were restricted to varying degrees, and there were no abnormalities in lower limb movement, sensory function, and tendon reflexes.

Lumbar spondylolisthesis and lumbar spondylolisthesis

1. X-ray performance

The diagnosis and extent of the disease are mainly based on plain radiographs. Anyone who suspects a diagnosis of this disease should routinely take positive, lateral and left and right oblique films.

2.CT, MRI examination

It can clarify the compression of the spinal cord or nerve root to assist in differential diagnosis. It is still an essential diagnostic method in those who must be diagnosed with other diseases or have neurological symptoms.

Diagnosis of lumbar spondylolisthesis and lumbar spondylolisthesis

The diagnosis of lumbar spondylolisthesis and lumbar spondylolisthesis mainly depends on clinical manifestations and X-ray examination. In addition, the clinical needs to check for other signs of low back pain, such as lumbar disc herniation, sprains and strains of the back muscles or ligaments.

Treatment of lumbar isthmus and lumbar spondylolisthesis

Non-surgical treatment

Non-surgical treatment is effective in most cases of spondylolisthesis, including non-steroidal anti-inflammatory painkillers, short-term bed rest, avoiding heavy loads and strenuous activities, wearing braces, lower back muscles and abdominal muscle exercises. After 6-8 weeks of treatment, symptoms can be improved, especially suitable for adolescents who are mature. Not every patient with spondylolisthesis or spondylolisthesis needs treatment. A considerable number of patients with spondylolisthesis and first degree lumbar spondylolisthesis are asymptomatic and do not require treatment.

2. Surgical treatment

It is ineffective for the treatment of low back pain or recurrence of non-surgical treatment. The patient can be treated with surgery for young and middle-aged patients with herniated disc, and at the same time the prominent herniated nucleus pulposus is removed.

(1) Surgical treatment of isthmus collapse: treatment of isthmus nonunion local bone grafting: for patients with lumbar isthmus nonunion, local bone grafting of isthmus nonunion is performed, that is, after removing the fibrous epiphysis of the isthmus nonunion, the transverse process of affected vertebra Bone grafting across the isthmus to the lamina does not fuse the joints. It can also be combined with screw internal fixation.

(2) Surgical treatment of lumbar spondylolisthesis Surgery includes: Relieve the compression of the pony tail or nerve root, and investigate whether there is compression of the fibrous epiphyseal hyperplasia in the isthmus or resection of the vertebral arch; Easy; fusion, intervertebral bone graft fusion or intertransverse (back lateral) bone graft fusion.