The vertebral bones that make up our spine are arranged on top of each other in an order. Normally, the anterior and posterior edges of the vertebrae align with the edges of one lower and one upper vertebra. The vertebrae are connected to each other with the help of discs in the anterior part and facet joints in the posterior part. Many ligament structures that increase the durability of this arrangement also form bridges between bones.

 

Lumbar spondylolisthesis, or colloquially known as lumbar sprain, occurs when two vertebrae slide over each other in the form of a stair step. As a result of this slipping event, our spinal cord, which passes through the spine, is compressed and complaints such as pain, numbness and burning occur in both legs.  Findings may occur at a young age or may occur in advanced ages due to aging of the spine.

 

There are 6 types of waist slip:

• congenital lumbar deviation

• Lumbar shift due to isthmic defect

• Degenerative (aging-related) waist slippage

• low back slip due to trauma  

• Lumbar slippage due to pathological causes such as tumor, infection

• Lumbar slippage after surgery

 

The most common causes of waist slippage are slippages due to isthmus (Pars) defect and due to aging.

About 5% of people may have a developmental fracture in the lower lumbar region of the bone that connects the upper and lower joints of the vertebrae. These fractures are called “spondylolysis”. Fractures that occur due to the fact that this region is very mobile may not heal most of the time. However, while these fractures usually cause pain during development, they may not cause serious problems in adulthood. In some patients, the upper vertebrae may slide forward relative to the lower spine due to fracture. Depending on the amount of slippage, it can cause more serious problems.

Another type of lumbar slippage is lumbar slippage, which is seen due to the wear and tear of the spine and surrounding connective tissues as a result of aging. It is usually seen in women and most frequently in the L4-5 distance. It is called degenerative spondylolisthesis. Narrow canal often accompanies degenerative lumbar shifts.

Stress fractures may not always show clinical signs. Sometimes it can occur by chance in waist films shot for other reasons. If the slip causes a complaint, the first complaint is usually pain in the lumbar region. Waist slippage may not show any symptoms even years after slippage occurs. Symptoms seen include back and hip pain; numbness in the legs, pain, muscle tension, weakness, increased lumbar inclination or difficulty walking. Although these symptoms are relieved temporarily by rest, the pain usually increases with standing, walking and other activities.

  

Postoperative slippage  most of the time, it is revealed due to excessive removal of the joints connecting the spine in the first surgery.

 

It is divided into 4 according to the degree of slippage of the waist slip.

• 1st degree slip is less than 25%,

• Less than 50% in 2nd degree,

• Less than 75% at grade 3 and

• In the 4th degree, it is between 75% and 100%.

 

Diagnosis

Diagnosis begins with a detailed physical examination of patients. The history of pain and numbness told by the patients in slips that cause compression in the nerves guides experienced physicians in terms of diagnosis. Again, the neurological examination of the patients gives information about the slip zone.
 

Radiographic tests are very important in the diagnosis of waist slippage. In determining the type of treatment, the increase or decrease of the slip with the waist movements is very meaningful for the physicians. This is determined by radiographs taken while patients bend forward and backward. In addition, standing scoliosis (posterior, anterior and lateral) radiographs should be taken to see the balance of the entire spine in these patients.
 

Stress fractures are often undetectable on plain radiographs. Computed tomography examination of suspicious cases would be appropriate. The definitive diagnosis is made by MRI (Magnetic resonance) in the diagnosis of nerve compression due to slip and narrowing of the spinal canal. Your doctor may also refer to the EMG (Electromyography) test when necessary.

 

Treatment

It is appropriate to follow-up stress fractures and lumbar shifts that do not cause complaints. Again, relief in complaints can be achieved with rest, painkillers and anti-inflammatory drugs, temporary corset use, and one or more of the physical therapy methods in first-degree slippage. If there is leg pain and numbness due to nerve compression along with low back pain, epidural or foraminal injections can be added to the treatment.

If the patient's waist slippage is more than 1st degree and reveals signs in the patient, or if the degree and angles of slippage change in motion films (if there is a mechanical disorder), the patient should be treated surgically. Again, if stress fractures seen in adolescence cause pain and limit the activities of young people, they should be treated surgically. The most appropriate method in surgical treatment is determined by your physician. Generally, the preferred method is to fix the slippage, if possible, by supporting the fractured area with bone grafts to weld it together with screws and a cage in between. Since spinal canal narrowing and nerve compression are also detected in these surgeries, patients are also treated in the same surgery to relieve these pinched nerves. Thus, recovery is achieved in the short term and patients can regain their previous activities without any restriction in waist movements.

 

Surgical treatment is required if the disease causes complaints that do not decrease with drug therapy, causes nerve compression findings and progresses in the shifts that occur in advanced ages. The recovery process is supported by the rehabilitation programs applied after the surgery.