Spondylolysis and spondylolisthesis means slipping from one vertebra to another, a sign of instability of the spine . 
The affected vertebrae most often are L4 and L5, while it is very rare at the level of the vertebrae above. 
Most of the spondylolistesis are anterolistese, ie sliding forward, it is rare to find a retrolistese or laterolistese. 
It affects about 5% of the population.


Lumbar extension exercise

Types of spondylolisthesis

Depending on the severity is divided into degrees, from I to V, the first degree spondylolisthesis corresponds to a vertebral body sliding less than 25% of the length of the vertebral plaque. 
The other degrees are progressively more severe up to the fifth or spondyloptosis corresponding to a slip of approximately the entire base of the vertebra to a position in front of the underlying vertebra. 
In this condition, the spine is likely to be inflamed and painful. 
There are two types of spondylolisthesis: degenerative and spondylolysis.

The first is usually derived by arthrosis and causes loss of joint relationships between the vertebrae, usually not exceeding the second degree and affecting predominantly the female gender and those over 50 years of age. 
Degenerative spondylolisthesis may be a complication of surgery or may be the result of infection or neoplasia. 
The situation is most severe in the case of degeneration of the longitudinal ligaments, facet joints and capsuloligamentary structures. 
Degenerative spondylolisthesis is characterized by narrow spinal canal and root conflict.



Spondylolysis is the interruption of the continuity of the vertebral isthmus which is the bone that connects the superior to inferior joint process and the spinal process. 
Spondylolisthesis may be associated with spondylolysis. 
This orgina fracture slowly in patients genetically predisposed to about 6 years, evolves during development, but usually stabilizes in adulthood and does not occur modifications.

The lesion may also occur after repetitive microtraumas (stress fracture) if the isthmus is not very strong and over time can not be consolidated. Over time, the vertebral body and upper transverse processes tend to move forward and downward relative to the underlying vertebra (spondylolisthesis).

In certain cases, you begin a healing process that serves the isthmus, but the vertebra is stretched and stretched forward, it is possible that it heals on one side only.

What are the symptoms ?

Model of the lumbar spine with vertebrae, discs and nerve roots

It is possible that individuals with spondylolysis do not feel any pain, but if you start x-ray and find spondylolysis, there were probably some episodes of low back pain .

Lumbar pain episodes are more common in adults than in children. 
The pain can be as simple or, in more severe cases, accompanied by root pain such as sciatica or cruralgia .

The pain is not very strong and is located in the area where the vertebra has slipped. 
Extension enhances symptoms, flexion reduces pain. There is rarely a disc herniationbetween two involved vertebrae, but is often present on top of them


How do you get diagnosed?

Magnetic resonance imaging of L5 with lysis at the back of the vertebra

The most appropriate examination and lumbosacral radiography . In lateral projection it is possible to see: the severity of the slip of the vertebra, the height of the underlying disc and a possible lesion of the isthmus.

The plates are made in position of maximum flexion and extension, leaning forward while decreasing with the extension backwards, there is no evidence that the vertebra is unstable.

Magnetic resonance imaging shows a possible compression of the nerves, particularly those below the displaced vertebra. 
The intervertebral disc in the adult will encounter the strong degeneration and therefore, it diminishes the available space of the nerve roots. 
To evaluate the function of the nerves that originate from the vertebra with spondylolisthesis, an electromyography and the study of the nerve conduction that visualizes the nervous condition and a possible root suffering are useful.


What to do? What is the treatment?

The Diathermy apparatus.

Treatment may be conservative or surgical. 
Conservative therapy is preferred to avoid intervention, if spondylolisthesis is modest, the results may be excellent. 
The exercises of postural gymnastics: the strengthening of the abdominal and paravertebral musculature, give greater stability to the lumbar spine. If the pain does not subside, experts often recommend ultrasound or  TECR therapy to resolve the inflammation . 
Today, the prescription of rigid braces that immobilize a part of the spine and reduce hyperlordosis is avoided.
In the long run, the disc that is slipped under the vertebrae can degenerate and become thinner until it disappears. In this way, the two vertebrae are approaching until the union and the ossification. 
If the pain is chronic and very strong, an arthrodesis surgery may be indicated, ie a stabilization of the vertebrae by means of synthesis that fix one to the other.

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