WHAT IS SPONDYLOLISTHESIS?
Spine is formed with the regular array of structures called vertebra. There are 33 vertebrae in tour body. 24 of these vertebrae are mobile. 5 of the vertebrae are located in the low back. When anatomical structure of the vertebrae are observed, there are 3 main structures. These are vertebral body, bone roof protecting spinal canal at the back, called lamina and facet joints which allow the vertebrae to connect. In addition, as it is explained in detail in the part of herniated disc, there are structures called discs which distribute the load in an equivalent way and provide flexibility of the spine. Basically, lumbar spondylolisthesis is the slip of 2 vertebrae on each other, causing compression on the spine and nerve roots, and accordingly causing symptoms in the patient. Sometimes, this slipping is caused by the development of a developmental crack between the lumbar spine and tail bone (sacrum), a vertebra shifts forward over the next vertebrae, so that isthmic spondylolisthesis occurs. In addition to this type of spondylolisthesis, there is a degenerative type spondylolisthesis caused by arthritis of the joints between other vertebrae and the destruction of the disc structure between the vertebrae.
WHAT ARE THE SYMPTOMS OF SPONDYLOLISTHESIS?
The patients may experience back, low back pain, power loss and numbness in feet. The most significant finding in patients are cramp and spas in the feet after walking. By time, these findings are seen in a shorter time and in advanced periods, patients experience cramp and spasm during walking even at home. If the patients get rest while walking, the complaints decrease. Then, when they start to walk again, they face the same problems. The patients may have pain starting in the low back and hip and radiating to the feet.
HOW IS IT DIAGNOSED?
Spine array and radiological anatomical structure, diameter of the nerve roots, if any, bone defects and degenerative changes are evaluated in x-ray imaging. Computed tomography or 3-D computed tomography of the vertebrae provide more detailed information. In addition, 3-D imaging provides a more detailed defining for spinal canal. Computed tomography is required to measure to determine the size of the systems to be used to fix the spine such as screws or rods which may be used during surgery. As computed tomography displays the bones and osteoarthritis better, it provides information on the location where bone defect is present. Magnetic resonance (MRI) is an essential method to evaluate the anatomical structure of disc structures located between vertebrae, face joints where vertebrae joint and ligaments connecting the vertebrae, thecal sac and nerve roots. Slipping-dependent compression of spinal cord and nerve roots is clearly evaluated with MRI.
WHAT ARE THE TREATMENT OPTIONS FOR SPONDYLOLISTHESIS?
Treatment is classified under 2 topics as non-surgical and surgical methods. If there is just low back pain and nerve root compression is not detected, if there is not power loss in the legs or feet, if mobility is not detected in the direct x-ray of lumbar vertebrae, in that case non-surgical treatment methods should be used. Non-surgical methods do not provide repair of he structures destructed mechanically (cracked and/or slipped vertebra), however they increase the participation of the patient in the daily and work life with pain control. These method are taking rest, painkiller and antienflamatuar medication, movement restriction program, use of corset and physical treatment. Control of disease findings with non-surgical treatment methods will be possible by ensuring that the patient does not gain weight, learns how to do daily activities easily and adopts it as a lifestyle. If the paint is not taken under control with the above-mentioned methods without power loss, consultation may be requested from the physicians of physical medicine and rehabilitation or physicians interested in algology. For patients having pain that cannot be taken under control with non-surgical methods, power loss in legs and/or feet, urinary and/or fecal incontinence, surgical treatment should be considered. In that case, decompression, i.e. Removal of the compression on the nerve root, should be applied to relieve compressed nerve root, and then the vertebra fixation procedure known as platin screw by the people and as fusion in medicine should be carried out. Patients working in office jobs can get back to work after 1 month. However, patients doing body works should wait for 2 months. Some patients may need physical medicine and rehabilitation program after the operation.