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Spondylolisthesis in younger and older people
Spondylolisthesis has several possible causes of formation, but these two groups cover patients with two of the most common causes. In younger people, chiropractic arises from a chiropractic fracture, a situation in which a small part of the vertebra gets damaged and there is a break in the continuity of the bone. The vertebra becomes more mobile. The spine works as if normally, that is, we load it, bend it, straighten it, make rotational movements, but of itself it has lost a bit of stability, because it has gained new mobility. This is usually the result of biological loads: different vertebral arrangements, because some people can afford to have more movement between vertebrae, and some can't. It is also sometimes associated with excessive physical activity involving flexion and extension.
In the elderly, chiropractic arises on the basis of degenerative disease - everything is in place, nothing is damaged, but the elements that should take part in stabilizing the vertebrae are so worn out that they are unable to provide these stabilizations.
Symptoms of chiropractic develop slowly
In either case, there is a situation in which one vertebra moves forward in relation to the other - we always say that the higher one moves in relation to the lower one. As a rule, symptoms are almost never very pronounced right away, and develop slowly. At first they affect only the lumbar or lumbosacral region. This means pain that bothers, but after a while of rest passes, such as after prolonged bending, sitting, and in younger people - after a classic overload. In younger people, who are still physically active, the problem often becomes the performance of movements in which there is an overstretch, i.e. bending the trunk backwards.
Spondylolisthesis - diagnosis - pictures are the most important!
As a rule, this injury is associated with the development of a local focus of pain, but sometimes, when the vertebra shifts, there may also be pain in one of the limbs. Patients are often treated by a general practitioner, a neurologist, also an orthopedist, but the most important thing is to perform basic diagnostics, i.e. a simple photo.
This disorder can be clearly seen, while patients often undergo treatment for overload lesions and say that, surprisingly, they feel worse after rehabilitation. In the case of chiropractic, rehabilitation should undergo some modifications to that used for overload lesions. If it is neglected, additional symptoms will appear, discomfort will become constant and regular, not only at times of overload. As a rule, in such cases, pain also manifests itself in the lower extremities, and in the elderly a rather characteristic symptom is a problem with movement. After walking a certain distance, patients complain that the limbs become "not their own" - heavy, tired, as if they do not listen to them. Only after resting for a while can they walk further. Such a situation is called lameness, in this case neurogenic, because it results from extreme narrowing of the space for nerves. The spine works abnormally, and in the process the space for the nerves is reduced. Losing patients experience a moment of great pain the moment they want to change position, and once they change position, such as standing up straight, the discomfort quickly diminishes.
Rehabilitation is the basis for chiropractic.
Diagnosis is very important in this situation - the doctor uses a photograph, and if patients have a problem with the lower extremities, a CT scan or MRI is additionally recommended, depending on the cause. Once the injury is diagnosed, the patient is most often referred for rehabilitation treatment - physiotherapists work on correct muscle tone, correct trunk alignment, but also on secondary changes. Such as poor hip function, which is related to chiropractic. The most important thing - the patient must know what can harm him!
He shouldn't work in flexion for long periods of time, perform overstretching movements, and if he works sitting down, he should pay attention to his own trunk muscle stabilization. Conscious patients with a chiropractic problem and given proper rehabilitation can live for many years without much pain! This condition, unfortunately, will never go back. In the case of my patients, once a year I recommend taking a picture, because it can happen that a person does not feel pain, and the chiropractic begins to slowly worsen. Just by stabilizing it, the patient can safely return to daily life.
Spondylolisthesis: when surgery?
We can also treat spondylolisthesis with surgery if rehabilitation fails. We then stabilize those vertebrae that slide into each other, and if in addition there is a neurological problem, such as constant radiation of pain to the lower extremities or chroma, we are able to take care of it surgically. First: we then stabilize the spine so that the vertebrae slide together. Second: we undo the vertebroplasty as much as possible, although it is not always possible to do this to zero. If the disease process has been going on for 30 years and has been slowly growing, all the structures in the area have been gently adjusting to it, and a sudden retraction could work the opposite, that is, compress the nerve structures and magnify the problems. So we try to reposition the chiropractic, decompress it so that the nerve structures have more room - this is done through a surgical process with implants. It is usually very successful - especially when the patients have been well matched. That is: they went through the rehabilitation process, there was a big improvement, but the injury came back and did not respond to subsequent rehabilitation treatment. Surgery should also not be performed too early.
Surgery is not a standard treatment for chiropractic. We set the treatment in this direction when the patient appears with very large complaints, lameness, pain in the lower extremities. Their great intensity greatly interferes with daily life.
Spondylolisthesis - rehabilitation always helps
After decompressive surgery, usually with stabilization, the patient must undergo a rehabilitation process. As a result, he gains knowledge of how he should function properly with his spine, which is based on implants. Rehabilitation consists of specific exercises, incorporated into the process one at a time. At first they are simple tasks - the patient learns how he should sit, how to lift. However, they allow control of the figure. Most patients see the need for rehabilitation on their own, and after a period of 6 to 12 months, they learn to function well enough in life to know when something starts to bother them. The return to work life is usually faster, although it also depends on the job. It occurs three to six months after surgery.
Spondylolisthesis - stay under the doctor's control!
It remains important to remain under the doctor's constant control. Due to damage to certain elements of the vertebra, for example, deterioration may occur, and it will not be because the patients did something wrong. This is because the spine loses its properties and its stability with age.
Spondylolisthesis - how to sleep?
For adequate recovery, it is essential that daily sleep be of the best possible quality. This refers both to minimizing pain that can interfere with sleep or awaken during the night, and to minimizing passive overload in the musculoskeletal system, which can affect function upon awakening. According to patients, physiotherapists alike, the position on the side with the lower limbs partially flexed at the hip and knee joints most often provides the conditions mentioned above. This is also confirmed by scientific studies.
What can't be done in chiropractic?
Spondylolisthesis, when considering it causally, is a condition with a mechanical basis. Therefore, whether any activity or activity is more or less appropriate in a patient with chiropractic depends most on what movement or alignment of the spine is predominant. Forward and backward bending movements should be minimized, especially if they are repeated for a long time or the body is held motionless in that position for a long time. The more the spine is placed in a neutral position, the lower the risk of developing or aggravating the ailment. Of course, there are activities in which forward-backward bending is necessary. The solution is to perform them primarily at the hip joints.
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Bibliography:
- Paul Gagnet, Kent Kern, Kyle Andrews, Hossein Elgafy, Nabil Ebraheim, Spondylolysis and spondylolisthesis: A review of the literature, Journal of Orthopaedics, Volume 15, Issue 2, 2018, Pages 404-407
- Andrew K. Chan, Viraj Sharma, Leslie C. Robinson, Praveen V. Mummaneni, Summary of Guidelines for the Treatment of Lumbar Spondylolisthesis, Neurosurgery Clinics of North America, Volume 30, Issue 3, 2019, Pages 353-364
- Akkawi I, Zmerly H. Degenerative Spondylolisthesis: A Narrative Review. Acta Biomed. 2022 Jan 19;92(6):e2021313
