The back injury that is the forward slip of one vertebra over another is known as spondylolisthesis, usually occurs in children between 9 and 14 years as well as in athletes who undergo the backbone to much stress as in the release, wrestling, dance, golf, football, powerlifting, weightlifting and gymnastics.
Isthmic spondylolisthesis, which is the most common form of this condition can be caused by a faulty gene on bone formation of the vertebrae, and secondly the physical stresses applied to the vertebral column components break weak or inadequately trained, so that repeated heavy lifting, bending, or twisting can cause small fractures in the vertebral structure and cause the slippage of one vertebra over another. It is usually the fifth or last lumbar vertebra (L5) that slips past on the first sacral vertebra (S1).
Spondylolisthesis can occur in varying degrees depending on the length of displacement of the vertebra, which is measured by X-rays from the inside.
Grade I: anterior displacement of 25%
Grade II: anterior displacement greater than 25%
Grade III: anterior displacement of more than 50%
Grade IV: anterior displacement of more than 75%
Symptoms of Spondylolisthesis
When anterior displacement is equal to or less than 25% (Grade I) there will be no symptoms and can ignore the person that has a defect in the spine.
In cases where anterior displacement exceeds 25% (Grade II, III and IV) presented low back pain that may or may not radiate to the legs, pain increases in activities that require trunk bending backward (extension), and may feel a “creak” in the back at point of anterior vertebral displacement.
Muscle spasms may also occur, pain or weakness in the legs, tight hamstrings and irregular motion. In severe cases the disease can lead to curvature of the spine and bulging of the abdomen, shortened torso, and staggering gait or duck.
Diagnosis of Spondylolisthesis
If you have any recurrent back pain or more of these signs need to see a doctor to perform a proper diagnosis and subsequent treatment. In the first consultation will talk to your doctor about the symptoms, their severity, and treatments received for pain.
Then the specialist physical examination should be carefully examined to determine if there are limitations of movement, balance problems, and pain. During this examination the doctor will also see if there is loss of reflexes in the extremities, muscle weakness, loss of sensation or other signs of neurological damage.
As the case may be required attachments are diagnostic tests, starting with standard projection radiographs with anteroposterior, lateral and oblique views of the lumbosacral spine that can rule out other problems, you may also be necessary to use computed tomography (CT) or magnetic resonance (NMR) to confirm the diagnosis. Including a myelogram may be necessary, a test that includes the use of a liquid dye is injected into the spinal column to show the degree of nerve compression and slippage of the affected vertebrae.
Treatment of spondylolisthesis
In children and adolescents with asymptomatic spondylolisthesis the treatment is controversial, however seems to be a general consensus not to apply any treatment if the slip does not exceed 25% and to restrict contact sports and physical activity severe landslides from 25% and 50%.
In most cases of isthmic spondylolisthesis, especially Grades I and II, when there is pain or other symptoms the treatment consists of temporary bed rest, restriction of the activities that caused the onset of symptoms, pain medications and anti-inflammatory steroid-anesthetic injections, physical therapy and / or spinal bracing.
What can the athlete?
- Avoid activities that cause or increase pain.
- Can continue to train but avoid those exercises that engage the back.
- Stretch your hamstrings are tight because if you can rotate the pelvis backwards in relation to the vertebra forward.
- Do exercises to strengthen abdominal.
- Use a lumbar support to prevent excessive movements of trunk flexion.
- Visiting a physiotherapist for treatment.
What can the doctor and physiotherapist?
- Prescribe exercises to strengthen.
- Resort to surgery if the treatment is not effective rehabilitation.
Surgery is required in severe cases usually Grade III or higher, when there is neurological damage, when the pain is disabling, or who have failed all the options of treating non-surgical.
The most common surgical procedure used to treat spondylolisthesis is called a laminectomy and fusion, this procedure widens the spinal canal by removing or trimming the sheet or roof of the vertebra to create a larger space for the nerves and relieve pressure on spinal cord.
It may be necessary for the surgeon to remove all or part of the vertebral disc and also fuse vertebrae. If a merger may be necessary to do a bone graft and fusion with the implantation of various devices such as screws, rods, hooks or interbody cages to strengthen and support the spine unstable.
Prevention and back
It is impossible to prevent all back problems and particularly of the spine, but there are things we can do to keep healthy: Avoid or limit activities that cause significant efforts to the column, lose weight, start a program of regular exercise, not smoking and learn proper body mechanics are things that can help reduce the risk of additional back problems.