Lumbar Listhesis (Lumbar Spondylolisthesis) Treatment

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Lumbar Listhesis

A forward slip of a vertebra is called a lumbar slip. It often occurs in the lumbar region. Lumbar slippage is a condition that occurs mainly as a result of the fracture or separation of this joint, which is called the facet joint and holds the vertebrae together at the back.

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Lumbar slippage is more common in men. Lumbar Listhesis is seen in 5-6% of men and 2-3% of women. This is due to physical activities.

This is the reason why it is more common in men, since it is a more common disease in people who perform excessive physical activity and do heavy work.

Low Back Slip (Lumbar Spondylolisthesis) Complaints

Low back slippage does not occur with specific complaints in most people. Lumbar slippage is found incidentally in x-rays taken to detect a different problem. However, from time to time, a few problems may present themselves.

Complaints of lower back pain that intensifies and increases after working and getting tired,
Increased curvature in the waist
Pain or weakness in the legs, thighs and feet
Decreased stool and urinary functions,
Cramps in the calf,
In advanced cases; changes in posture and gait. (The patient can walk in a depressed state.)

Lumbar Listhesis Diagnosis

Lumbar tomography, two-way x-ray, MRI and moving waist x-ray may be required to diagnose lumbar slippage. Usually, X-ray film and MRI are sufficient.

The extent of the slippage can be determined by moving X-ray film, and if the slippage is more than 4 mm, surgery is usually required. With MRI, it is checked to what extent the nerve is under pressure, whether there are other pathologies such as herniated disc or narrowing of the canal, and the necessity of surgery is decided accordingly. Bone pathology is well seen on tomography and the fracture site can be clearly identified.

Lumbar slippage is graded with the tests performed. While Grade 1 (GR-1) expresses the situation with the least slip, the situation with the most slip refers to Grade 5 (GR-5). These values show how far forward it slides over the adjacent spine.

• % Grade 1
• P Grade 2
• u Grade 3
• 0 Grade 4

If the Grade 5 spine has completely fallen down over the adjacent spine, it is called spondyloptosis.

Lumbar Listhesis Treatment

First of all, medical treatment is done. These are usually pain relievers and muscle relaxants. It may not be helpful in advanced cases. Physical therapy can also be done. The corset can be used and may provide partial benefit. In cases where physical therapy is not helpful and medical therapy does not help, or if the patient has a heart or lung disease that prevents surgery, pain therapy is applied in this case.

Facet nerve blockade and transforaminal nerve injection are the most appropriate treatment modalities for these patients. With an average of 10 minutes of operation and 20 minutes of rest, the patient's pain is significantly reduced. Its effect lasts for an average of 6 months. It can be repeated several times a year.

When all these treatments do not help, in cases such as concomitant lumbar hernia or narrowing of the canal, if the patient's complaints gradually increase, the decision for surgery is taken.

If the problem is a moving back slip, it is called an unstable condition. The slip increases with movement and puts pressure on the nerves, thus causing pain in the legs. For this reason, this movement must be prevented.
In other words, the two vertebrae that have slipped over each other are attached to each other with screws and made immobile and stable.

At the same time, nerves that may be under pressure are released. This treatment is decided by the physician by looking at the MRI and its clinic. Simultaneous scopy is taken in order to minimize the risk of error in screwing operations. In experienced hands these screws are life savers.

The operation takes an average of 2 hours.