What is lumbar spondylolisthesis?
Lumbar spondylolisthesis (from the Greek “spondulo” which means vertebra and “listhesis” to slide) therefore corresponds, as its name suggests, to the sliding of a lumbar vertebra forwards or downwards, dragging with it the vertebra located just below, even in the most extreme cases, the rest of the spine. This slippage mostly affects the low lumbar levels (L3-L4, L4-L5 and L5-S1) and causes sharp pain in the lower back.
There are 4 stages of increasing severity of this instability of the spine.
What are the causes and risk factors of lumbar spondylolisthesis?
There are three types of lumbar spondylolisthesis, each of which has a different origin.
First, lumbar spondylolisthesis by isthmic lysis. This is a frequent lesion that affects on average 4 to 8% of the population (generally sporty adolescents who practice gymnastics, rowing or horse riding – or sports that generate significant pressure on the back -) . Concretely, it will be a “stress fracture” of the isthmus (bone bridge connecting one vertebra to the other). This fracture most commonly occurs on the L5 lumbar vertebra. This is in fact the place where the column is hollow and is most sensitive to mechanical stresses.
Second lumbar spondylolisthesis, degenerative or arthritic lumbar spondylolisthesis. Slippage is secondary to the appearance of osteoarthritis of the joints between the vertebrae. This slippage is linked to age, to intense physical exertion or to the repetition of heavy lifting.
Of congenital origin, dysplastic lumbar spondylolisthesis is rarer. It results from a malformation of the L5 lumbar vertebrae and / or sacrum during growth, which most commonly occurs in adolescents or young adults.
What are the symptoms of lumbar spondylolisthesis?
Lumbar spondylolisthesis can be completely asymptomatic regardless of the cause. In symptomatic patients, on the other hand, the main clinical sign of this slippage is pain:
- low back pain (pain located in the lumbar vertebrae). Usually they appear when the individual is in motion or standing).
- sciatica (pain corresponding to compression of the anterior root, driving the sciatic nerve). Sciatica occurs mostly after a certain age with the development of osteoarthritis.
- excessively hollow back
- paresthesia (tingling sensation, numbness)
- weakness in muscles
- bosse en bas du dos
- certain neurological disorders (motor deficit, paralysis of the lower limbs, loss of stool or urine – cauda equina syndrome – or even loss of sensitivity in the pelvis). Much rarer, these symptoms constitute a surgical emergency.
How to diagnose this pathology?
Imaging is essential in the diagnosis of this pathology. Clinical signs alone are not sufficient to confirm or deny the diagnosis.
In first intention, x-rays allow to make the diagnosis and to identify its cause. They will then be completed by an MRI, a CT scan or a myelography.
What possible treatments?
When spondylolisthesis is asymptomatic, radiographic monitoring may be necessary every 1 to 5 years, depending on the age of the affected person. However, in the absence of painful manifestation, there will be no prescribed medical treatment or surgical indication.
In case of moderate and episodic pain, medical treatment based on analgesics, anti-inflammatory drugs and physiotherapy will be indicated to the patient. In case of sharper and more frequent pain, surgical intervention may be considered.
How to prevent lumbar spondylolisthesis?
As explained earlier, there are several types of lumbar spondylolisthesis of different origins. Thus, lumbar spondylolisthesis by isthmic lysis can be prevented by avoiding the multiplication of activity practices that require a significant use of the back.
Lumbar spondylolisthesis can be avoided by adapting certain work gestures (adaptation of the workstation in the case of jobs with strong constraints), certain positions and the carrying of heavy loads.
For people with lumbar spondylolisthesis, radiographic monitoring is also recommended.