Slipped vertebra (Spondylolisthesis).
Chronic back pain is often caused by a slipped vertebra
Chronic, deep low back pain is one of the most common clinical pictures seen in the human population. The causes for this can be diverse and are often associated with changes to the bony structures in the vertebrae, the discs and the ligaments. One of these causes is a slipped vertebra, something that is present in 6% of the population.
What is meant by a slipped vertebra?
The term "slipped vertebra" is used when two vertebral bodies are displaced and tilted in relation to one another. The backwards displacement of the upper vertebra on the underlying vertebra is called a retrolisthesis. An anterolisthesis, more commonly known as a spondylolisthesis, is the forwards displacement. The sideways displacement and rotation of a vertebra is called a rotary spondylolisthesis. Slipped vertebrae are further differentiated into congenital slipped vertebrae where a so-called spondylolysis, i.e., a defect between the joint surfaces in the vertebra´s bony ring (so-called interarticular position), is present. This gap between the two vertebral joints can cause a vertebra to slip. This slippage causes the forward displacement of the front part of the vertebra (vertebral body), the bases of the bony ring, the transverse processes and the upper joint processes. In contrast, degenerative changes to an intact bony ring (interarticular region) caused by wear and tear are often associated with arthritis in the vertebral joints and lax ligaments.
Symptoms & causes of slipped vertebrae at a glance.
Symptoms. What happens in vertebra slide?
What are the symptoms of a slipped vertebra?
50% of patients with spondyloses and spondylolistheses (slipped vertebrae) do not have any symptoms at all; they are asymptomatic patients. Changes are often only discovered by chance. The symptoms are deep back pain and, as a rule, pain that does not clearly arise from nerves (pseudoradicular). In rare cases, nerve pain in the back (radicular pain) can also be a symptom. Nerve dysfunction causes a reduction in muscle strength and results in muscle weakness and signs of paralysis. The pain gets worse on loading and the overstretching of ligaments and is associated with a feeling of subjective instability. In rare cases, sensory disorders can appear in the anal and genital regions, with impaired bladder and bowel function possible.
Slipped vertebrae in children.
Particularly children with high-grade spondylolistheses (slipped vertebrae) have stiff hips and a stiff lumbar spine. When the leg is raised, the entire trunk lifts up at the same time as a reaction to the pain; back pain may radiate into the feet. Sensory disorders may appear in the legs, with changes in sensation or numbness possible.
Causes. How do vertebrae slip?
In cases of congenital slipped vertebrae:
Mechanical overloading, e.g., from loading in the swayback position in gymnastics, butterfly swimming, spear throwing and ballet when still growing, can change loading and function in the area between the joints of the vertebral body. Excessive curvature of the lumbar spine (hyperlordosis = swayback) can promote the development of spondylolysis and the subsequent slippage of vertebrae (spondylolisthesis).
In cases of degeneration-related slipped vertebrae:
In this type of slipped vertebrae, degeneration-related disc laxity and vertebral joint arthritis cause a forwards slipping of the vertebra on the underlying disc and the vertebra below. Slipped vertebrae are seen in approx. 5-7% of all cases. The 5th lumbar vertebra is affected most often. Slipped vertebrae are present at this level in 80% of the cases. The 4th lumbar vertebra is affected in 15% of the cases. The vertebra mostly starts to slip (=spondylolisthesis) between 12 and 17 years of age.
Diagnostics & Therapy
Slipped vertebrae of the spine can be treated with conservative measures, spinal surgery and rehabilitation.