Slipped vertebrae. Diagnostics & Therapy
A thorough diagnosis helps to find the best treatment.
Back pain can have many different causes, such as a muscular overload or an unfavorable attitude in the workplace. Mostly these discomforts pass after a while by itself when the cause of the complaints were resolved. Prolonged pain in the back can also be due to an instability of the spine, such as the occurrence of spondylolisthesis (spondylolisthesis).
If spondylolisthesis was diagnosed, the best treatment approach is discussed with the patient in order to take the necessary treatment steps.
Depending on the nature and degree of instability, we treat spondylolisthesis with conservative measures or as part of a surgical treatment. After an operation on the spine, a subsequent rehabilitation can help you to get strong for everyday life again.
Diagnostics & Therapy of osteochondrosis of the spine.
Diagnostics. How spondylolisthesis is diagnosed
Assessment of slipped vertebrae.
An extreme swayback may be present. In addition to this, the back muscles are tense and painful to touch. A step can be felt between the spinous processes in high-grade slipped vertebrae. The legs may become weak when nerve symptoms are present, e.g., weakness when straightening the knee and lifting up or lowering the foot. Sensory changes (e.g., pins and needles) may also be present in the thigh and the lower leg in particular. In some cases the nerves may be irritated, with the tendon reflexes being either diminished or absent as a result.
Instrument-based diagnostic tests for slipped vertebrae.
X-rays are used to take standard images of the lumbar spine from the front to the back (sagittal) and from the side. When applicable, functional images in the maximal forwards and backwards bending positions can also be useful to document the spondylolisthesis dynamics, i.e., the instability of that segment. If the vertebra has slipped sideways, functional images from the side are also taken when bending maximally to the left and the right. Oblique images can demonstrate the spondylolysis area when necessary. However, the use of these images as a routine diagnostic test is no longer justified nowadays due to the exposure to radiation.
Magnetic resonance imaging is used to assess both the spinal canal and the nerves within. This method can also be used to evaluate the possible compression of nerve roots and the dural sac (the layer of tissue surrounding the spinal cord) as well as secondary changes to the morphology, such as cysts in the joints and protruding/slipped discs.
Myelography (using contrast medium to see the spinal canal) and myelography in combination with computer tomography (CT-myelography) are mostly only carried out when magnetic resonance imaging is contraindicated. Myelographies are rarely indicated though and are not appropriate as a routine test. If neurological abnormalities are present, it may be necessary to conduct electromyography tests and assess the speed of nerve conduction.
Therapy. How we treat splipped vertebrae
What types of treatment are available for slipped vertebrae?
Slipped vertebrae that are asymptomatic and have been discovered by chance during radiological testing do not require treatment. If a patient is known to have a spondylolysis and a slipped vertebra, load-related sports where the trunk bends backwards (extension) should be avoided, e.g., javelin, ballet, gymnastics, butterfly stroke, etc. It is recommended that the progress of the disease be monitored radiologically during the growth phase to limit the amount of slippage.
Conservative therapy for slipped vertebrae.
Conservative therapy is always used to treat symptoms when the slipped vertebra has not caused neurological deficits such as paralysis or sensory changes. Physical therapy exercises to stabilise the stomach and back muscles with the lumber spine flattened are also worth a particular mention here. Parallel to this, excessive body weight - if present - should be lost until the normal or ideal weight range is reached. A temporary trunk orthosis, often in the form of an elastic corset, must be worn over a short period to relieve symptoms. Depending on their pain, patients may also receive pain-relieving medication (e.g., non-steroidal anti-inflammatories) and muscle relaxants.
Surgery for slipped vertebrae.
Surgery is indicated when conservative therapy measures fail and the deep back pain remains (persistent back pain), when radiological investigations demonstrate increased vertebral slippage in children, and when neurological symptoms are present and continue to get worse (progressive). A temporary trunk plaster cast can be worn that flattens the lumber spine to confirm the diagnosis (provisionally) and imitate the surgical fusion. The operation itself usually involves reconstructing the anatomical profile of the spine. A screw and rod system is attached to the affected vertebrae, normalising the anatomical alignment of the back edge of the vertebral bodies. The screws can pull back the slipped vertebra into its original position on the underlying vertebra. The screws are connected by a so-called longitudinal carrier, in short, a pedicle screw and rod system.
Surgical fusion for slipped vertebrae.
When screws and rods are used alone, there is a risk of the implant failing due to the screws loosening in the bone or, in rare cases, the implant breaking. It is therefore wise to additionally carry out biological fusion surgery using the so-called anterior interbody fusion procedure. In this procedure, a load-carrying cage made of titanium, plastic or other materials is placed between the vertebrae. The space between the vertebrae and the cage is then filled with the patient´s own bone or a bone replacement material such as hydroxylapatite or BMP (bone morphogenetic protein). The cage can either be put in place from the front (anterior implantation via a small incision) or from the back (transforaminal or interlaminal technique); for the biological fusion of the segment. The so-called in situ fusion is less favourable from a biomechanical point of view. In this procedure, bone grafts are placed between the two transverse processes without the position being corrected (intertransversal fusion). A pedicle screw and hook system and autologous bone grafts make it possible to reconstruct the isthmus in youths younger than 18 to 20 years of age who suffer from spondylolysis without vertebral slippage. Microscopic decompression may be necessary in cases of significant spinal nerve compression. During the initial phase of bone growth, the patient is immobilised using a flat-back orthosis for a period of 12 weeks following the operation.
Post-operative rehabilitation for slipped vertebrae.
Post-operative immobilisation in the stabilising corset lasts for 12 weeks. Stabilising exercises for the stomach and back muscles can be carried out over this period. After the 12 weeks have ended, the patient is weaned off the corset over a period of approx.10 - 14 days and continues to carry out stabilising exercises for the stomach and back muscles.
Chronic, deep low back pain is one of the most common clinical pictures seen in the human population and can be caused by spondylolisthesis.
Here you can find our specialised clinics & hospitals for diagnostics, treatment and therapy of spondylolisthesis at a glance.