Spondylolisthesis

Spondylolisthesis is the slipping of a vertebral body, anterior to the rest of the vertebrae. Appears in the lumbosacral region by sliding on the L5 and S1 but higher levels of the spine. It is classified according to etiology in five types: congeital or dysplastic, isthmic, degenerative, traumatic and pathological.The condition may or may not be associated with spinal instability.Some people remain asymptomatic even in severe landslides, but most charge discomfort. The disease can cause minimal symptoms or back pain, mechanical pain disability, nerve root compression and radiculopathy neurogenic claudication.Spondylolisthesis can occur at any level of the spine, lumbar spine is more common though. Most cases result from minor mechanical stress, trauma, repetitive hyperextension of the spine.
Cracks is spondylolysis vertebra especially pars interarticularis region, associated or not with spondylolisthesis. If it is bilateral pars defect may allow translation of the vertebrae with spondylolisthesis.Both conditions are often asymptomatic, and the degree of spondylolisthesis does not correlate with the severity of symptoms, even when patients complain of back pain. But the two entities are the most important causes of back pain in children and adolescents, despite the fact that most are asymptomatic.
Physical regimes reduce stress by extension of the lumbar spine and promotes nonlordotica position. Consisting of abdominal muscle stretching exercises, wearing harnesses and strengthening the fascia lombodorsale. Tijarea with ortoza toracolombosacrala offers relief for those who do not respond to rest or daily activities which cause symptoms. This type of rod is effective for patients with less than 50% slip. If slip is below 50%, but symptomatic therapy is recommended noninterventionala: stretching exercises, antilordotica rod, changing activities. If the pain continues to recommend spinal fusion.
Many cases can be treated conservatively, however, for people with disabling symptoms, radiculopathy, neurogenic claudication, abnormal posture or weight and resistant to nonoperative measures indicate significant progress has sliding surgery. Wants to stabilize the spinal segment surgery and decompression of neural elements.
Pathogenesis of spondylolisthesisSpondylolisthesis is the process by which a vertebral body slips over the rest of the axis of the spine stability. The etiology is multifactorial condition. There is a congenital predisposition to type 1 and 2, and the patient's posture, gravity, rotational forces and the high concentration of stress are additional pathogenic factors.Type 1: Type is dysplastic or congenital defect in the upper sacrum or arch L5. There association with spina bifida occulta and severe damage to nerve roots.Type 2: type the isthmic defect occurs in the pars interarticularis before slipping the upper vertebra, usually L5. There are three subcategories:-Lithic-spondylolysis, or stress fracture-Elongated but intact pars-Acute pars fracture.Type 3: form is a degenerative condition caused by degeneration gained chronic articular disc and girls incompetence, leading to segmental instability and a gradual sliding, usually at L4-5.Spondylosis is a general term for degenerative changes of the spine mediated age that can lead to this type of spondylolisthesis.Type 4: as traumatic fractures result from any part of the neural arch or pars (vertebral body) which leads to listhesis.Type 5 is produced by pathological type of generalized bone disease such as osteogenesis imperfecta or Paget's disease.
Spondylolisthesis may be divided according to quantitative vertebral subluxation in the sagittal plane:One-degree-below 25% of the diameter of the vertebral-Grade 2-25-50%-Grade 3-50-75%4-75-100%-level-Spondiloptoza-over 100%.Dysplasia spondylolisthesisOccurs through a defect of the neural arch in the upper sacrum or L5. 95% are associated with spina bifida occulta. Pars interarticularis is the bone of the lamina, pedicle, transverse processes and articular faces. This portion of the vertebra can withstand strong forces during ambulatiei. This area can be congenital deficiency or present microfracutri repeated mechanical shocks.Isthmic spondylolisthesisEte most frequently. Placing cause mechanical stress on the weakened pars fractures and fissures. These false joint will heal with a bridge that crosses the bow or bone fracture fibrosis. Most defects are caused by stress fractures that persist because ambulatiei continue.Degenerative spondylolisthesisPars interarticularis is not affected by degeneration.Intersegmentala lasting instability leads to degenerative spondylolisthesis. Changes daughters develop joint osteoarthritis.Erosions appear abnormal articular surfaces aligned. Other factors include abnormalities ligementelor, the intervertebral disc (decrease in height).Pathological spondylolisthesisMalignancy or infection can affect the pars interarticularis, facets or pedicles. Malignancy such as metastasis of breast cancer, prostate and lung, and myeloma are the causes of spondylolisthesis.