SPONDYLOLISTHESIS
(SPINAL SLIPPAGE)

Spondylolisthesis is the forward or backward displacement of one vertebra over another. In medical terminology, the term spondylolisthesis is used for spinal slippage. In the presence of spondylolisthesis, the spinal cord and nerves passing through the spinal canal can be stretched, compressed, and placed under pressure.

ANATOMY

Your spine consists of 24 small rectangular bones called vertebrae, stacked on top of each other. These bones are connected to form a canal that protects the spinal cord.

Spondylolisthesis occurs in the lumbar spine. The five vertebrae in the lower back make up the lumbar part of the spine.

Other parts of your spine include:

Spinal cord and nerves. These “electrical cables” pass through the spinal canal, carrying messages between the brain and muscles. Nerve roots exit the spine through the vertebral foramina.

Facet joints. There are small joints between the posterior parts of the vertebrae that provide stability and help control spinal movement. Facet joints provide balance and stability (strength) and allow the spine to bend and twist.

Intervertebral discs. Flexible intervertebral discs are located between the vertebrae. These discs are flat, round, and about half an inch thick. Intervertebral discs cushion the vertebrae and act as shock absorbers during walking or running.

CAUSES OF SPONDYLOLISTHESIS

The causes of spondylolisthesis include congenital anomalies of the spine, traumatic injuries, athletic activity, heavy exercise and strength training, and degenerative changes, which can occur in children, adolescents, and adults.

SYMPTOMS

Spondylolisthesis pain starts in the center of your lower back and radiates downward. In many cases, patients with spondylolisthesis do not have significant symptoms. It may not even be detected until a radiograph is taken for an unrelated injury or condition. When symptoms do occur, the most common symptom is lower back pain.

* A feeling of muscle tightness;

* Buttock, leg, and sacral pain;

* Pain decreases with rest;

In patients with spondylolisthesis, it can cause additional signs and symptoms, including muscle spasms:

* Back stiffness;

* Difficulty straightening up and walking;

Patients with spondylolisthesis may experience numbness or weakness in one or both legs. These symptoms result from pressure on the spinal nerve root as it exits the spinal canal near the site of the slippage.

CLASSIFICATION OF SPONDYLOLISTHESIS

The Meyerding classification is based on the degree of displacement of the upper vertebra relative to the one below it.

• Grade 1 – displacement of the vertebra is not more than 25%;
• Grade 2 – vertebra displacement is not more than 50%;
• Grade 3 – vertebra displacement is not more than 75%;
• Grade 4 – vertebra displacement is more than 75%;
• Grade 5 – complete displacement of the vertebra off the one below (spondyloptosis);

DIAGNOSIS OF SPONDYLOLISTHESIS

The Professor performs a physical examination of the patient – palpation of painful areas, checking tendon reflexes, skin sensitivity, muscle strength, and nerve root tension.

To confirm the diagnosis, additional imaging studies are necessary. The most informative methods for spondylolisthesis are spinal radiographs and magnetic resonance imaging (MRI). Radiography can reveal the degree of spondylolisthesis, while MRI enables the assessment of the spinal cord and nerve roots that may be involved in the disease process.

TREATMENT
Our private hospital, EKOL, has a qualified medical team. Professor Dr. Erol YALNIZ guarantees a proper diagnosis, preparation, and professional treatment of the disease. Spondylolisthesis treatment is carried out following an algorithm to treat pain associated with spinal instability or nerve root compression. The indication for surgery is the ineffectiveness of conservative treatment in managing the pain syndrome.

Surgical Treatment – Posterior Instrumentation
Spinal fusion is essentially a “welding” process. The basic idea is to join the affected vertebrae together so that they heal into a single, solid bone. Fusion eliminates motion between the damaged vertebrae, providing stability. The theory is that if the painful segment of the spine does not move, it should not hurt.

In surgical treatment, the nerves in the area of slippage are decompressed (freed), and the vertebrae are stabilized with instrumentation to prevent further progression of the slippage. The surgical procedure can be performed from the front (anterior), back (posterior), or both sides (combined). The recovery process is supported by post-operative rehabilitation programs. Before discharge, our patients are taught daily movements in detail, such as getting out of bed, walking, and climbing stairs. Your hospital stay is 3 days.

Contraindications:

• Acute or chronic infections;
• Intolerance to the materials used;
• Bone diseases such as severe osteoporosis, osteopenia, or osteomyelitis;
• Poor medical or psychological condition that may worsen during surgery;
• Intrachanal abnormalities (diastematomyelia, etc.);
• Anatomical abnormality of the pedicle;