SPONDYLOLISTHESIS

From Big Medical Encyclopedia

SPONDYLOLISTHESIS (spondylolisthesis; Greek spondylos a vertebra + olysthesis sliding) — the acquired dislocation of the vertebra in relation to underlying. The term entered in 1854 Mr. Kilian (N. Kilian). S.'s emergence is connected with patol. changes of an intervertebral disk, to-rye often develop with defect in the interarticular site of an arch of a vertebra — a spondylosis.

The page meets more often in nizhnepoyasnichny department of a backbone at the L3-5 level of vertebrae, in rare instances — at the C6-7 level of vertebrae. The spondylosis more often happens bilateral, seldom comes to light at two levels.

Fig. 1. The diagrammatic representation of various degrees of a dislocation of the vertebra at a spondylolisthesis on classification of Meyerdinga: and — norm (it is given for comparison); — the I degree (the rear edge of a body of the V lumbar vertebra is shifted on 1/4 in relation to an upper surface of a sacrum); in — the II degree (the rear edge of a body At a lumbar vertebra is shifted on 1/3 in relation to an upper surface of a sacrum); one or III degree (the rear edge of a body of the V lumbar vertebra is shifted on 3/4 in relation to an upper surface of a sacrum); d — the IV degree (the rear edge of a body of the V lumbar vertebra is shifted more than on 3/4 in relation to an upper surface of a sacrum); the body of the displaced vertebra is shaded.

On the most widespread classification of Meyerdinga (H. W. Meyerding, 1932), 4 degrees of a dislocation of the vertebra defined on the roentgenogram in a side projection distinguish. At the I degree the rear edge of a body of the displaced vertebra is shifted to 1/4 in relation to an underlying vertebra, at II — to 1/2, at III — to 3/4, at IV — from 3/4 to a full dislocation of the vertebra (fig. 1). To the ship's boy and Kyul (Junge, Kuhl, 1956) added to this classification the V degree — the full shift of a body of a vertebra of a kpereda from underlying.

On a way of I. M. Mitbreyt and V. E. Belenky (1978), degree of a dislocation of the vertebra is determined on the roentgenogram by a corner between the vertical axis and the line connecting the centers of the slipping and below-located vertebrae. Shift of L5 of a vertebra on 46 — 60 ° corresponds to the I degree of shift, on 61 — 75 ° — the II degrees, 76 — 90 ° — the III degrees, 91 — 105 ° — the IV degrees, 106 — 120 ° and more — the V degrees of shift.

Distinguish unstable and stable Page. At nestabilnokhm S. relationship between displaced and below-located vertebrae changes with change of a pose of the patient, at stable it does not occur.

S.'s character is defined not only by degree of shift, but also the reasons which caused it, a type of shift. On Uiltsa, to Newman and Maknab (L. L. Wiltse, R. N. of Newman, I. Macnab, 1976) distinguish the dysplastic S. caused by anomaly of development of the basis of a sacrum or plate of an arch of L5 of a vertebra (at the same time there can be no defect in an interarticular part of an arch); the spondilolizny S. caused by slowly arising defect like a change for fatigue in the extended interarticular part of an arch and sharply arising defect in an interarticular part of an arch; degenerative, or involute, S. depending on intervertebral instability (without defect in an interarticular part of an arch); traumatic S. as a result of a change of joint shoots or an interarticular part of an arch; the pathological S. arising at such diseases as an arthrogryposis (see), Pedzhet's disease (see. Pedzheta disease ), etc.

Dysplastic S. develops at children and teenagers against the background of gradual lengthening of the interarticular site of an arch and transformation of joint shoots of a sacrum (up to their full aplasia) and deviations of a kzada of the lower joint shoots of the displaced vertebra. At the expressed anomaly of development of an arch of the lower lumbar vertebrae and a back wall of the sacral channel shift can reach the III—V degree.

S.'s Spondilolizny arises both at children and teenagers, and at adults, and shift at children's and teenage age usually does not exceed the I degree, and adults have II degrees.

Degenerative S. is more often observed at advanced and senile age in the absence of defect in the interarticular site of an arch of a vertebra. At this form C. the lower joint shoots of the displaced vertebra deviate kzad, and upper joint shoots of the below-located vertebra — a kpereda.

Clinically The page is shown by the moderated or expressed pains in lumbar, sacral, coccygeal areas, the lower extremities. Localization of pains depends on the level of a dislocation of the vertebra and age of the patient. Pains in lumbar area at patients of mature age are quite often combined with pains in chest and cervical departments of a backbone, in sacroiliac joints. Children and teenagers are disturbed more often by the lower extremity pains. At S. find a ledge deepening over an acantha of the displaced vertebra, profound lumbar lordosis (see), the strengthened chest kyphosis (see), the basin inclined forward (the sign comes to light hl. obr. in an initial stage of a spondylolisthesis at children), the basin turned back (comes to light already from the II degree of a dislocation of the vertebra). At the expressed dislocation of the vertebra find shortening of a trunk, specific elongation of top and bottom extremities, a contracture of the muscles straightening a backbone (a symptom of «reins»), deepening of a back furrow, asymmetry of a rhombus of Mikhaelis, Schumacher's symptom (supraplacement from a navel of the line drawn from top of a big spit through an upper front ileal awn), an atrophy of gluteuses, a contracture of muscles of a sgibately shin, etc.

As a rule, at a palpation of an acantha of the displaced vertebra and an intervertebral disk through an abdominal wall, and also at the level of a dislocation of the vertebra at longitudinal loading pain develops.

At a part of patients are noted nevrol. frustration, many from to-rykh are caused by the expressed changes in the vertebral channel. During the standing or walking paresthesias — heavy feeling in legs, crawlings of goosebumps, etc. are observed. Paresis and an atrophy of muscles of the lower extremities, disorders of sensitivity (in the form of a hypesthesia, a hyperesthesia, a dizesteziya), decrease or loss of Achilles, belly, proctal and kremasterny reflexes, increase in knee jerks come to light (see. Akhillov reflex , Belly reflexes , Knee jerk , Reflex ), symptoms of Lasega, Nery (see. Radiculitis ), the lower symptom of Brudzinsky (see. Meningitis ), vegetative frustration. The syndrome of a horse tail can be observed: cruel radicular onychalgias, sacrum, buttocks, crotch, sluggish paresis and anesthesia of the lower extremities, anesthesia of a crotch, incontience of urine, etc.

Fig. 2. The roentgenogram of the bottom of lumbar department of a backbone of the patient with a spondylolisthesis of the IV lumbar vertebra against the background of a spondylosis (a side projection): the body of the IV lumbar vertebra is displaced in relation to an underlying vertebra forward; the arrow specified a crevice in the interarticular site of an arch of a vertebra (spondylosis).

To distinguish the shift of vertebrae and to estimate it quantitatively allows rentgenol. research. Existence of a spondylosis at S. can be revealed in usual pictures of a backbone in direct and side projections (fig. 2). Rentgenol. the research allows to distinguish also accompanying pathology (a spondylosis, a spondylarthrosis in the struck segment, a displastichny sagittal arrangement of the planes of dugootrostchaty joints, an aplasia of joint shoots, the extended arch of a vertebra), extent of deformation and narrowing of the vertebral channel and intervertebral foramens. Insignificant shift of bodies of vertebrae is determined on the roentgenogram in a side projection by step deformation of the line connecting back contours of bodies of vertebrae.

By means of a functional rentgenol. researches (in provisions of an inclination forward, back, aside) reveal the initial phenomena of S., to-rye on usual roentgenograms can not be defined. It can be at the same time established, shift is unstable or stable as a wedge, manifestations depend first of all on existence patol. mobility in the field of an intervertebral disk. At stabilization of a segment, even in the provision of mutual shift of vertebrae, expressiveness patol. signs decreases, gradually appear rentgenol. symptoms of deforming spondylosis (see).

In need of an operative measure rentgenol. the research is conducted for the purpose of identification of degree of shift and fixing of the displaced vertebrae, character and extent of deformation of the vertebral channel, a condition of arches and shoots of vertebrae, etc. For the solution of these tasks, except a usual and functional X-ray analysis, sometimes resort to tomographies (see), to a contrast research of the vertebral channel and intervertebral disks (see. Discography ).

Treatment at Page I of degree at children and teenagers conservative. The plaster bandage taking the part of a thorax, a basin and the lower extremities (to knee joints) bent in hip joints at an angle 150 ° for the term of 10 — 12 weeks is shown (see. Plaster equipment ). Further (within 6 — 12 months) use a rigid corset. Long periodic observation, in particular for children with the expressed abnormal development of a plate of an arch of L4 — L5 of vertebrae and a back wall of the sacral channel is necessary. To the patient appoint rest, stay in halfbent situation on spin, to lay down. physical culture, massage, corsets of various design, fizio-and balneoterapiya, dignity. - hens. treatment (Pyatigorsk, Nalchik, Hop garden, Sochi, Saky, Yevpatoria, Belokurikha, Shira, etc.). For removal of an acute pain syndrome appoint analgetics, sacral and peridural blockade of 0,5% solution of novocaine.

An operative measure is shown at the progressing S. (since the II degree of shift) at children and teenagers, at the unstable form C. which is not giving in to conservative treatment. It is directed to a possible reduction of the displaced vertebra and stabilization of a backbone at the level of shift by means of various devices or front spondylodesis (see). After operation of the patient within 2 — 4 months stays in halfbent situation on spin, and then uses a rigid corset till 1 year. At a stenosis of the vertebral channel, existence of rough changes in a meninx, arachnoidal cysts, disturbance of a likvoroob-rashcheniye it is shown laminectomy (see) with audit of the vertebral channel at the level of a dislocation of the vertebra with the subsequent or simultaneous spondylodesis.

Forecast at timely treatment of S. favorable.

Prevention Page and spondylosis at children's age consists in their perhaps early identification and dispensary observation for children with pathology of a bearing, in particular with patholologically profound lumbar lordosis, lumbar scoliosis. At adults for prevention before employment or before the sports activities connected with rise in considerable weights carry out rentgenol. research of lumbosacral department of a backbone. The expressed anomalies of development of lumbosacral department of a backbone, including. sacralization (see), are a contraindication to performance of hard physical activity or occupations by certain sports. Women during pregnancy and after the delivery in order to avoid deepening of a lumbar lordosis are recommended to strengthen muscles of a stomach, to be engaged to lay down. gymnastics to use a bandage, not to wear shoes on a high heel.



Bibliography: A. A cake layer. Osteoplastic fixing of a backbone at severe forms of a spondylolisthesis, Ortop. and travmat., No. 4, page 40, 1965; A. A. Cake layer and X in and with yu to N. I. Open reposition of vertebrae with a spondylodesis at spondylolistheses, in the same place, No. 6, page 21, 1972; M and t-breyt I. M. Spondilolistez, M., 1978, bibliogr.; T and e r And. JI. and D I am a h e the Tax Code about V. A. Radiodiagnosis of diseases of a backbone, page 108, M., 1971; They are e r I. L. and M and z about I. S. Radiodiagnosis of shifts of lumbar vertebrae, M., 1979; T at r N e r G. I. Spondilolistez, his essence, clinical implication and value in change of a statics of a body, Vestn. hir., t. 6, No. 16, page 3, 1926; X in and with yu to N. I., etc. The device for open reposition displaced on calls, Ortop. and travmat., No. 2, page 69, 1977; Tserl yu sq.m. Backbone operations, Riga, 1980; C and in I am Ya. L. Hirurgiya's N of a backbone, page 278, M., 1966; H and to l and V. D's N. Radical operation of the author at a spondylolisthesis and a tubercular spondylitis, Vestn. hir., t. 58, No. 6, page 577, 1939; In about with h e r J. E. VV. Die Wirbelverschie-bung in der Lendengegend, Lpz., 1958; Meyerding H. W. Spondylolisthesis, J. Int. Coll. Surg., v. 26, p. 566, 1956; Monticelli G. Ascani E. Spondylolysis and spondylolysthesis, Acta orthop. scand., v. 46, p. 498, 1975; T an i 1 1 a r d W. Les spondylolisthesis, P., 1957; W i 1 t-s e L. L., Newman P. H. a. M a with-n a b I. Classification of spondylolisis and spondylisthesis, Clin. Orthop., No. 117, p. 23, 1976; Z i p p e 1 H. Wirbelgleiten in Len-denbereich, Lpz., 1980.


I. M. Mitbreyt; P. L. Zharkov (rents.).

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