Lysesis or spondylolisthesis refers to the displacement of one vertebra over another. I will explain why and how this happens. The image we see is a lateral view of the vertebrae of the lower back (lumbar region). When standing, the effect of gravity causes the vertebra above to tend to slide down as shown with an arrow. The vertebra below would be like a slide for the vertebra above. This does not happen in healthy people for many reasons. There are bone stops that prevent it and then there are also all the ligaments, musculature and other “soft” structures that hold everything in place.
Listesis (spondylolysis / spondylolisthesis) the main reason for not sliding the vertebrae is in the bone stops. These stops are the prominences of bone that form the joints of the back of the vertebra (as we see represented with red lines). These areas of bone collide with each other and do not let the vertebra slide forward. When this area of the vertebra breaks, instability is created that causes the vertebra to begin to slide. This rupture is called spondylolysis.
How much does it slide off your site? Although the cause is the same there is not the same degree of displacement of the vertebra in all the people. This depends on many other factors. Doctors separate it in degrees depending on how much displacement there is:
- Degree I: When there is a displacement of 25% of the measurement of the vertebral body.
- Grade II: The half of the body of the vertebra has slipped.
- Grade III: In this situation 75% of the vertebra has slipped leaving only 25% of the body of the vertebra in contact with the one below.
In the vast majority of cases (approximately 90%), the bone lesions that cause listesis occur in the L5 vertebra. If the L5 vertebra slides over the S1 vertebra we are talking about a L5-S1 spondylolisthesis.
We already know that the fracture of this area of the vertebra produces the listesis, but, why it breaks? This can happen for several reasons:
– When you damage the bone stops that prevent the vertebra from slipping, we call it spondylolysis, as I mentioned. The word lysis refers to destruction. The breaking of these stops occurs especially during growth. In this phase the bone structures are more immature and we do not have an adequate muscular development yet to protect us. This way you can damage this area of the bone with repetitive gestures as in the practice of a sport and often go unnoticed for the affected or noticing significant back pain.
– We may have a birth defect (congenital) that causes the L5 vertebra to tend to slide in its support on the first sacral vertebra.
– In older patients, the chronic wear of the posterior joints of the vertebra causes greater stress on the ligaments that gradually give way and forming this deformity that is the listesis.
– An obvious cause that can also cause it is a trauma. If we have a major accident, the structures that hold the vertebrae in place can logically break. This can also occur if there is any disease in the bone like a tumor or similar, although this is very rare and improbable.
We have commented on how frequently the initial lesion in infancy is produced by this skeletal immaturity and the lack of solid musculature that stabilizes the vertebrae. When this area of the vertebra is damaged at growing ages the most normal thing is to have no symptoms or to have had back pain that has not been given much attention because it is not very intense. The discovery usually comes years later when we do an image test casually for other reasons or for back pain.
What should we do?
If we have symptoms on the back we must go to the doctor for a diagnosis. As for spondylolisthesis our doctor will tell us the cause that has caused us. Most will be mechanical causes of overuse but it is important to rule out the rare diseases that can cause it and that require other types of treatments.
If we are diagnosed of spondylolisthesis and have no pain or other symptoms or complications, we should not worry. There is no need to restrict our activities even sports, unless the doctor gives us a reason for it.
On the other hand, if we have pain, we must do sport rest for 2 to 4 weeks, especially children and adolescents since the injury may be recent and has the opportunity to heal. Sometimes this sporting rest must be prolonged for 3 months if the pain persists.
Do I have to do rehabilitation treatment?
In principle a specific treatment is not essential unless there are specific problems to solve. Keep in mind that many of these patients are children. The best initial treatment is to decrease activity and restrict sports activity. Only with this measure for the right time can it be sufficient treatment to overcome the problem. Then it is important to know our back and how to take care of it so as not to have relapses.
What can my child do to prevent a listesis?
The best thing to do is to limit sports activity when there is a slight back pain. We should not do intense exercise with back pain. Above all, avoid spinal hyperextension gestures such as pin-jumper or tennis-throw. We must avoid the temptation to force because we have a competition or similar that we do not want to miss. If you are very dedicated to a specific sport with competitions of a certain level, you should avoid relapses by specifically working the trunk musculature (abdominals and lumbar extensor muscles).
What can an adult do with an established listesis?
If we have a listesis in the lumbar vertebrae it is important that we do two things. On the one hand we must learn to watch our backs. A web of information like this can educate us to take better care of our back. On the other hand, it is advisable to maintain a good physical shape, especially of the abdominal and lumbar musculature. As a point to be taken into account, during exercise we should avoid too intense stretching of flexion in the lower back because it can trigger inflammation and pain.
Do I have to operate if I have a spondylolisthesis?
Fortunately, most patients will be able to be treated without surgery and will be able to lead a normal life without any limitation. However, there are cases where there may be risks or the presence of neurological symptoms. By neurological symptoms we refer to the effects that occur in the body when a nerve is damaged by being compressed by the instability of the vertebrae.
In summary, spondylolisthesis is a cause of low back pain which in most cases will be solved with simple treatments. Although magnetic resonance imaging shows the listesis, it does not mean that it has to hurt us. Most people, if you take care of yourself, will only have occasional discomfort without further problems. The most advanced degrees (grade III or higher) may have a higher proportion of chronic lumbago or other complications.
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