Spondylolisthesis and Spinal Instability

Patologie della Colonna Vertebrale

Vertical Tabs

Definition and Etiology

When the intervertebral disc is affected by severe degeneration, this may cause the onset of a condition called lumbar instability which is distinguished as:

A) Micro-instability of the spine: when the spine maintains its correct alignment, but the degenerated disc causes micro movements of the vertebrae that slide between each other, with consequent inflammation of the disc plate or of the vertebral joint and onset of back pain.

B) Macro-instability of the spine: when the spine loses its normal alignment and the vertebrae slip one over the other resulting in the condition defined as spondylolisthesis.

According to the magnitude of the sliding of one vertebrae over the other, spondylolisthesis is classified into four grades:

Grade 1: from 0 to 25%
Grade 2: from 25 to 50%
Grade 3: from 50 to 75%
Grade 4: Over 75%

Symptoms

The instability of the spine reveals itself by chronic and disabling lumbar pain that may get worse with phenomena of sporadic or recurrent articular blocks. This symptomatology, although it does not cause permanent neurological damage, can lead to important limitations in daily and working life, and becomes highly disabling.

Diagnosis

The anamnestic data must be combined with radiological images: a MRI of the lumbar-sacral spine (providing a comprehensive view and information about the status of the intervertebral disc and the ligamentous structures), a CT of the lumbar-sacral spine (which clearly shows the bone component) and a flexion and extension radiography (which makes it possible to assess the severity of the instability).

Treatment

The first treatment in case of spinal instability is a conservative one, pharmacological therapy (painkillers, muscle relaxants, neurotrophic drugs) and rehabilitation (through repeated cycles of physiotherapy, stretching, and muscular reinforcement).

Should the conservative attempt be unsuccessful, surgery may be considered.

The surgery consists in vertebral stabilization by means of peduncle screws, which are inserted into the vertebral body, the heads of the peduncle screws are connected to each other by titanium bars and, if necessary, by positioning a spacer (cage) in the disc space. When there are radicular symptoms, it is also recommended to perform a decompression of the vertebral canal (laminectomy).

These are very safe procedures performed under general anesthesia with the aid of radioscopic controls and intra-operative neurophysiological monitoring (IOM) that confirm the correct position of the fixation devices to the neurosurgeon while maintaining the integrity of the nerve structures.

On the first day after surgery, the patient is invited to stand up and she/he is dismissed from the hospital after three days. The patient can immediately resume her/his normal activity without major strains for about 2 months. After fifteen days from the surgery, it is crucial that the patient undertake an intensive physiotherapy program (massotherapy and postural re-education) in order to achieve a satisfactory post-operative result.

After 3 months, the patient may resume sports activities.

In the micro-instability the degenerated disc causes micro-movements of the vertebrae that slide between each other, with consequent inflammation of the disc plate or of the vertebral joint and onset of back pain, but the spine maintains its correct alignment.

In the macro-instability of the spine loses its normal alignment and the vertebrae slip one over the other resulting in the condition defined as spondylolisthesis.

In case of severe instability, the surgical treatment consists in vertebral stabilization by means of pedicolare screws, which are inserted into the vertebral body. The heads of the pedicular screws are connected to each other by titanium bars.

Request a consultation

Contact us