All right! Let's take the slippage of waist 4 as an example. The lumbar vertebra 4 is displaced forward relative to the lumbar vertebra 5. If the anteroposterior diameter of lumbar vertebra 5 is divided into four equal parts, and each degree of spondylolisthesis is four degrees, the symptoms and harm of lumbar spondylolisthesis are gradually increased.
The hazards of lumbar spondylolisthesis mainly include the following aspects:
1, the waist 5 is the tail of the whole spine, just like the first floor of a skyscraper, and the waist 4 vertebral body is like the second floor, which is the most heavily loaded floor of the building. It is precisely this place that has gone wrong, and the second floor has shifted sideways relative to the first floor. It is conceivable that this building will become crumbling. Similarly, the entire spine will become unstable due to the forward slippage of the lumbar vertebrae. Every time the waist is stressed, it will become unstable.
2. The foundation is unstable. Over time, problems will also occur between other vertebral bodies above. First, the intervertebral space between the lumbar vertebrae 34 will be affected. Because the normal trajectory between lumbar vertebrae 45 is abnormal, the normal trajectory between lumbar vertebrae 34 will become abnormal, which is characterized by accelerated degeneration of lumbar vertebrae 34.
3. Not only the adjacent intervertebral space is affected, but also the distant intervertebral space cannot be avoided. Clinically, it is often seen that serious spinal deformities such as scoliosis and kyphosis between the upper vertebral bodies gradually appear due to the slippage of the 45 gap of the lumbar spine. We often talk about fish begins to stink at the head.
4. Intervertebral dislocation caused by spondylolisthesis will produce shear compression on nerves.
When the vertebral bodies are arranged neatly, the diameter of the spinal canal formed by connecting vertebral holes is the largest. When the lumbar vertebra 4 slides forward, the nerves in the intervertebral foramen of the lumbar vertebra 4 and the lumbar vertebra 5 have nowhere to escape and have to be pressed by various dislocated structures, especially the nerve roots of the lumbar vertebra 4 running in the intervertebral foramen of the lumbar vertebra 4 and the lumbar vertebra 5 are tightly pressed by the stretched and deformed intervertebral foramen wall. Moreover, this oppression is still changing. Dynamic stenosis caused by spondylolisthesis has an effect on nerves. With the movement of human body, the vertebral body constantly changes position, slides, resets, slides again and resets again. It's like the waves constantly hitting the beach, even the hard stones are polished off and the water chestnut becomes smooth. Another example of impact injury is that when punching holes in a solid reinforced concrete wall during house decoration, an impact drill is used, that is, the drill moves back and forth constantly while rotating, so as to turn out the holes. It can be seen that the impact injury is greater than the ordinary compression injury. It's a pity that the nerve tissue is very fragile and can't regenerate, and it can't stand such an impact injury at all. The clinical manifestation is that the degree of nerve injury in patients with lumbar spondylolisthesis is generally serious.
So why is there slippage?
The answer is that there is something wrong with the structure that limits the forward sliding of the vertebral body. It is also necessary to briefly talk about the anatomical structure between vertebral bodies. The tissues connected between two adjacent vertebral bodies are soft: anterior and posterior longitudinal ligament, ligamentum flavum, interspinous ligament, supraspinous ligament and annulus fibrosus of intervertebral disc; The only hard part is the articular process. Soft tissue, even strong intervertebral disc restraint is limited. The key is rigid structure. The facet joint can not only allow a certain range of motion between vertebral bodies, but also limit excessive motion and vertebral dislocation. The articular process consists of the inferior articular process of the upper vertebral body and the superior articular process of the lower vertebral body. The inferior articular process here is connected with the whole vertebral body through the isthmus of lamina, which is very important. There are two problems with the isthmus. One is that it becomes longer due to tension during development; One is an isthmus fracture. The isthmus becomes longer and the slippage is generally not heavy, mostly one degree. We call it pseudospondylolisthesis, and most patients can be treated conservatively. Patients with isthmus fracture can be congenital dysplasia or acquired fracture under long-term stress concentration, either of which will lead to serious dislocation between vertebral bodies. We call it true spondylolisthesis, which is the absolute indication of surgery.
How to treat lumbar spondylolisthesis?
Note that there is a word "symptom" here, which indicates the clinical symptoms caused by lumbar spondylolisthesis. Lumbar spondylolisthesis is also a process from quantitative change to qualitative change from appearance to aggravation. At the initial stage of spondylolisthesis, there are no obvious symptoms, and even patients don't know at all. Later, symptoms such as waist discomfort, pain, severe pain and nerve damage gradually appeared. When the patient goes to the hospital for pain, the lumbar spondylolisthesis has actually changed from compensatory period to decompensated period, which is serious to a certain extent. Whenever I receive such a patient, the first consideration is the patient's clinical symptoms, the severity of low back pain and nerve injury, as the main basis for conservative treatment and surgical treatment. What needs to be emphasized here is that the main basis and goal of doctors' suggestions for surgery is the symptoms of patients. Surgery and various treatments are done to alleviate the pain of patients, not to make the images on the video film look good. When the lumbago and leg pain caused by lumbar spondylolisthesis seriously affects the patient's life and has no obvious effect after strict conservative treatment, surgery should be taken. If the patient suffers from true spondylolisthesis, that is, lumbar spondylolisthesis with spondylolysis, surgery should be taken more actively, because the true spondylolisthesis is serious and deteriorating rapidly, and only surgery can finally solve it.
The surgical principle of lumbar spondylolisthesis can be summarized in eight words: "decompression, reduction, fusion and fixation".
Decompression is to relieve the compression on nerves, reduction is to pull the slipped and displaced vertebral body back to its normal position, fusion is to fuse the restored vertebral body with bone graft to ensure that it will not slip again, and fixation is to provide immediate stability of the spine, reduce bed rest time and ensure the smooth healing of intervertebral bone graft. Nowadays, spinal surgeons are very lucky because we have a powerful tool for posterior traction, reduction, fixation and fusion of the spine-pedicle screw spinal internal fixation system. With the help of this system, spinal surgeons can perfectly complete the eight-character mantra "decompression, reduction, fusion and fixation" of lumbar spondylolisthesis surgery.
In this sense, today's patients with lumbar spondylolisthesis are also lucky: when we can't choose what kind of disease we have, we should be glad that our disease has a treatment.