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Degenerative spondylolisthesis - treatment
Manifestations and Symptoms of degenerative spondylolisthesis,Methods of treatment.
Each level consists of a spine in front of the intervertebral disc and facet joints at the rear. The intervertebral disc serves as a cushion sharp movements in the spine, while the facet joints limit movement. They allow you to bend and straighten the spine, but not allow them to most of the circular motion.
Over time, facet joints are inadequate and allow the spine to bend too much, resulting in slippage of one vertebra to another. This condition is known as degenerative spondylolisthesis, as related to the degeneration of the facet joints.
Degenerative spondylolisthesis is typical for men older than 65 years, that is older and thus more common in women than in men (3:1 ratio). Most often this form of spondylolisthesis occurs at the level of the 4th and 5th lumbar vertebrae, but may also be at the 3-4th lumbar vertebrae. At other levels of the spine, this form of the disease is rare. In addition, degenerative spondylolisthesis may occur in two - three levels of the spine.
The manifestations of degenerative spondylolisthesis
At the age of degeneration of facet joints are often wider, reaching the spinal canal, which leads to spinal stenosis. Therefore, the symptoms of degenerative spondylolisthesis are the same as in spinal stenosis. Patients often complain of pain in his leg, which is a manifestation of the sciatic nerve during prolonged standing, walking. During the same seat of pain, not usually happen, or are insignificant. This is due to the fact that in this position intervertebral holes expand and compression of nerve roots is reduced. In the standing position as the openings are narrowed and the nerve is compressed.
Stretching of the nerve can cause pain in the leg, but the actual nerve damage is rare. Note that in the lumbar spinal cord there, so even with the most pronounced pain of the spinal cord does not suffer. In that case, if the stenosis is becoming stronger or herniated disc appears, you may receive the cauda equina syndrome, which is marked dysfunction of the bladder and intestines. This syndrome is fortunately rare.
Pain in the leg - this is a typical symptom of degenerative spondylolisthesis. At the same time, some patients may not have back pain, while others - pain in the leg.
Methods of treatment of degenerative spondylolisthesis
There is a wide range of methods of conservative treatment of spondylolisthesis (medication, physical therapy) that may help with pain at the time of spondylolisthesis. But in most cases, patients must choose from three treatments: Changing the way of physical activity. Patients can change their usual activity, spending more time in a sitting position and less time with a walk. Epidural steroid injections. This treatment helps to eliminate pain and improve physical activity of more than 50%. Where possible, these injections can be used three times a year. Duration of the effect of these injections may be different for different patients. Surgical treatment. In patients with severe pain and decreased activity of choice may be surgery. at the same time it is This is to eliminate compression of the nerve and subsequent fusion of the vertebral bodies and their fixation. We do not recommend carrying only one decompressive surgery, as this leads to instability and the subsequent need for fusion.
Spinal fusion for degenerative spondylolisthesis is usually enough to effect a successful operation which is achieved in 90% of patients. It helps to reduce pain and improve physical activity. After surgery, the patient usually has to stay in the hospital for 1-4 days. However, the postoperative period after it can be quite lengthy, as it involves a large number of cuts. The recovery period can be up to one year. In most cases, it lasts three months. In this case, we note that the more the patient manifests activity after surgery, the better the fusion between the vertebrae.
Surgery for spondylolisthesis involves various complications. In this case most often there is a risk:
Development between the ununited psevdosustava vertebrae,
Damage to the fixing device
Prolonged pain
Degeneration of the adjacent vertebrae,
Infections
Bleeding
Expiration of the cerebrospinal fluid (CSF)
Damage to the nerve root,
Complications from general anesthesia.
Most of these complications are rare. Among the conditions, which increases the risk of these complications: Uren, obesity, a multilevel fusion, osteoporosis, diabetes, rheumatoid arthritis, previous interventions on the part of the spine.
Since degenerative spondylolisthesis is most common in the elderly (60-65 years), surgical treatment, they may be accompanied by some risk. This risk is primarily associated directly with the general state of health. At the same time in some patients, even in case of failure of conservative treatment surgery may be a risk to health, so you have to do epidural injections.
After surgery, the same degenerative changes can occur from the adjacent vertebra. In order to eliminate the extra stress on that bell, there are different devices that allow us to replace the function of facet joint.
