The back injury that involves the anterior displacement of one vertebra over another is called spondylolisthesis, usually occurs in children between 9 and 14 years as well as in athletes who subject the spine to much stress as in the release , wrestling, dance, golf, soccer, weightlifting, weightlifting and gymnastics.
Isthmic spondylolisthesis, which is the most common form of this condition can be caused by a faulty gene on bone formation of the vertebrae on the other hand the physical stresses applied to the vertebral column components break weak or inadequately trained, so that repeatedly heavy lifting, bending, or twisting can cause small fractures in the vertebral structure and cause the slippage of one vertebra over another.
Usually the fifth or last lumbar vertebra (L5) that slips past on the first sacral vertebra (S1). Spondylolisthesis can occur in varying degrees depending on the length of displacement of the vertebra, which is measured with X-rays from the inside.
Grade I: anterior displacement of 25%
Grade II: anterior displacement greater than 25%
Grade III: anterior displacement greater than 50%
Grade IV: anterior displacement greater than 75%
Symptoms of spondylolisthesis
Spondylolisthesis L5-S1. Displacement of the fifth vertebra lumbsr on the first sacral vertebrae.
Spondylolisthesis L5-S1. Displacement of the fifth vertebra lumbsr on the first sacral vertebrae.
When anterior displacement is at or below 25% (Grade I) there shall be no symptoms and can ignore the person that has a defect in the spine.
In cases where anterior displacement greater than 25% (Grades II, III and IV) shows that back pain may or may not radiate to the legs, the pain increases in activities that require bending of the trunk backward (extension), and may feel a “crick” in the back at point anterior vertebral displacement.
Muscle spasms may also occur, pain or leg weakness, tightness of the hamstrings and irregular motion. In severe cases the disease can cause deviation of the spine and protruding abdomen, torso shortening and unsteady walking or duck.
Diagnosis of Spondylolisthesis
If you have any recurrent back pain or more of these signs need to see a doctor to perform a proper diagnosis and subsequent treatment.
In the first consultation we will discuss with the doctor about the symptoms, their severity, and treatments received for pain relief.
Then the specialist proceeds to carefully examine the physical examination to determine whether limitations of movement, balance problems, and pain. During this examination the doctor will also see if there is loss of reflexes in the extremities, muscle weakness, loss of sensation or other signs of neurological damage.
Depending on the case will require supplemental diagnostic tests, starting with standard projection radiographs anteroposterior, lateral and oblique views of the lumbosacral spine help to exclude other problems may also be necessary to use computed tomography (CT) or magnetic resonance imaging ( NMR) to confirm the diagnosis. Even a myelogram may be necessary, a test that involves the use of a liquid dye that is injected into the spinal column to show the degree of nerve compression and slippage between involved vertebrae.
Treatment of spondylolisthesis
In children and adolescents with asymptomatic spondylolisthesis treatment is controversial, however seems to be a general consensus not to apply any treatment if the slip does not exceed 25% and to restrict contact sports and physical activity in severe landslides between 25 % and 50%.
In most cases of degenerative spondylolisthesis, especially Grades I and II, when there is pain or other symptoms is temporary bed rest, restriction of the activities that caused the onset of symptoms, pain medications and anti-inflammatory steroid-anesthetic injections, physical therapy and / or spinal bracing.
What can the athlete do?
- Avoid activities that cause or increase pain.
- Can continue to train but avoid those exercises that engage the back.
- Stretching the hamstrings are tight because if you can rotate the pelvis backward in relation to the vertebra forward.
- Abdominal strengthening exercises.
- Use a lumbar belt to prevent excessive movements of trunk flexion.
- Visiting a physiotherapist for treatment.
What can the doctor and physiotherapist?
- Prescribing strengthening exercises.
- Mobilize stiff joints of the vertebral column surrounding anteriorizada
- Resort to surgery if treatment is not effective rehabilitation.
Surgical
Surgery is required in severe cases usually Grade III or above, when there is neurological damage, when the pain is disabling, or who have failed all nonoperative treatment options.
The most common surgical procedure used to treat spondylolisthesis is called a laminectomy and fusion, this procedure widens the spinal canal by removing or trimming the lamina or roof of the vertebra to create a larger space for the nerves and relieve pressure on spinal cord.
It may be necessary for the surgeon to remove all or part of the vertebral disc and also fuse vertebrae. If fusion is done, you may need to do a bone graft and fusion with implantation of various devices such as screws, rods, hooks or interbody grids to reinforce and support the spine unstable.
Prevention and back
It is impossible to prevent all back problems and particularly the spine, but there are things we can do to keep healthy: Avoid or limit activities that cause significant efforts to the column, lose weight, start a program of regular exercise, not smoking and learn proper body mechanics are things that can help reduce the risk of additional back problems.
