Lumbar retrolisthesis symptoms
Surgery may be recommended if non-surgical treatments do not work and your symptoms are severe, persistent or suggest you have a compressed nerve in your spine. The screws and rods are usually left in place permanently. In some cases, the disc between the bones in your spine may also be removed. It'll be replaced by a small "cage" containing a bone graft to hold the bones in your spine apart.
The operation is performed under general anaesthetic , which means you will not be awake.
Surgery often relieves many of the symptoms of spondylolisthesis, particularly pain and numbness in the legs. But it's a major operation that involves up to a week in hospital and a recovery period lasting months, where you have to limit your activities. Read more about lumbar decompression surgery , a type of spinal surgery used to treat compressed nerves in the lower lumbar spine.
Of the two, retrolisthesis is not common. Grade 1 retrolistheses, C3-C4, C4-C5. The neck is subjected to stresses as it supports the head at rest and during different movements.
It may cause symptoms related to other spinal disorders, such as spinal stenosis, facet joint dysfunction, cauda equina syndrome lumbar spine , and intervertebral disc bulge or herniation. The grade of a retrolisthesis is important to assessing the stability of the adjacent facet joint.
Retrolisthesis symptoms vary greatly and depend, in part, on the grade of vertebral displacement and how the adjacent structures are affected by the backward slippage. There are different spine-related problems that can cause or contribute to the develop of retrolisthesis. The diagnosis of retrolisthesis involves a physical examination and neurological evaluation that include details about your medical history and symptoms.
Thereafter, standing x-ray imaging of your spine is performed eg, anterior, posterior, lateral. The retrolisthesis may be viewed on the x-ray or other imaging study. Using the image, your doctor can measure its displacement how far out of normal position.
Vertebral Slippage (Spondylolisthesis & Retrolisthesis)
If the displacement is more than 2 millimeters, your doctor may diagnose you with retrolisthesis eg, Grade 1. Depending on the outcome of your neurological exam and review of symptoms, your doctor may order additional imaging tests , such as a CT or MRI scan. If your doctor tells you that one of your vertebrae has slipped backward, you may immediately assume that spine surgery is your only option. There are many considerations before advancing to surgery, such as the retrolisthesis grade, stability of the slip and its risk for progression, symptom severity, and your response to non-operative therapies.
Surgery is rarely needed. Non-surgical treatments may involve a single therapy or a combination, and are often successful at managing the inflammation, pain and related symptoms. If spine surgery is recommended, your doctor will explain exactly why it is necessary, the surgical goals and type of procedure. For example, a progressive or high grade retrolisthesis may require spinal stabilization using instrumentation and fusion to prevent the condition from worsening.
As stated earlier, retrolisthesis can cause other problems, such as spinal stenosis that may require surgical decompression eg, laminectomy to relieve nerve impingement. Your doctor may suggest nutritional support to improve and maintain your bone and joint health. Specific vitamins, such as vitamins A, C, and D, and nutrients like calcium and protein can be integral to long-term spine health.
If they are set in such a way that they are overloaded then whilst the bones are still soft in childhood, the supporting bone will fracture.
Spondylolisthesis - Physiopedia
Because the load persists and continuous movement takes place between the bone ends the fracture fails to heal leaving a defect held together by cartilage and fibrous scar. In later life either as a teenager or often in mid life, the disc degenerates the internal mass of the disc breaks up and leaves the body, the disc shrinks and looses height.
The disc wall becomes slack and the vertebrae become freer to slide around and overriding increases.
Here the facet joints have been separated from continuity with the vertebral body and can no longer control the direction or extent of travel and the unhealed fracture stretches and the boundaries of the exit canal Foramen consisting of the disc and overriding facets of the facet joint and fracture site, distort. In this situation the slide takes place in a backwards direction. This slide is in the main controlled by the orientation of the facet joints behind and ligaments and muscles attached to the vertebrae but the backwards direction may be directed by the natural overarching posture of the patient.
The slippage usually arrests at an override of 5mm. Vertebral Slippage is associated with various combinations of back, buttock and leg pain, numbness and muscle weakness.
The back pain may arise from irritation within the disc wall but more commonly arises from the pinching of the trapped nerve in the exit doorway Foramen from the spinal column. The foramen is distorted and the nerve is tethered by years of scarring reaction to repetitive bruising, can not evade the pinching by the bulging distorted disc wall or overriding facet joints or fracture margins in the case of Spondylolytic Spondylolisthesis. When advanced the compression causes numbness and weakness to develop. Unfortunately the patient may present with degeneration at more than one disc level.
The complexity of the spinal region means that a wide range of possible conditions exist to confound diagnosis.