The spine is a structure formed by the regular arrangement of structures called vertebrae on top of each other. There are 33 vertebrae in our body. 24 of them are mobile. 5 of the vertebrae are located in the lumbar region. When looking at the anatomical structure of the vertebrae, three basic structures stand out. These are the body of the vertebra, the bony roof called lamina at the back that also protects the spinal canal, and the facet joints that enable the vertebrae to articulate with each other. In addition, as explained in detail about lumbar disc herniation, there are structures called discs between the vertebrae, which ensure the equal distribution of the load on the vertebrae and the flexibility of the spine.
In its most basic form, lumbar spondylolisthesis occurs when two vertebrae slide over each other to certain degrees. It slips and compresses the spinal cord and the nerve roots coming from it, causing symptoms in the patient. This slippage sometimes occurs with the progression of a developmental crack between the lower lumbar spine and the tailbone (sacrum), and one vertebra slides over the other, creating adult type lumbar slippage (isthmic spondylolisthesis). Apart from this type of lumbar disc, there is also a degenerative type of lumbar disc, which occurs due to arthritis of the intervertebral joints and deterioration of the intervertebral disc structure.
What are the symptoms of lumbar disc?
Back, waist pain, loss of strength in the feet in patients. and numbness may occur. The most obvious symptom in patients is cramps and contractions in the legs after walking a certain distance. Over time, the walking distance at which these findings appear decreases, and in later periods, patients face cramps and contraction problems in their legs even during walking periods at home. If walking patients rest when cramps and spasms occur, their complaints will decrease. Then, when they start walking again, they face the same problem again. Patients may experience pain that starts from the waist and hip and spreads to the leg and foot.
How is the diagnosis made?
In X-ray imaging, the alignment of the vertebrae and the radiological anatomical structure, the canals where the nerve roots exit. Diameter, bone defects, if any, and degenerative changes are evaluated.
Computed tomography or 3D computerized tomography of the vertebrae provides the above-mentioned information in more detail. Also 3D image These help to visually define the inside of the spinal canal in more detail. Computed tomography is also required to make measurements to determine the size of spinal stabilizing systems such as screws and rods that should be used in surgery. Since computed tomography shows bones and calcifications well, it gives a clear idea about which area has a bone defect.
Magnetic resonance imaging (MRI) examines the disc structures located in the distance between the vertebrae, the facet joints where the vertebrae articulate with each other, and the vertebrae together. It is an indispensable diagnostic tool to evaluate the ligament structures that hold it together, the spinal cord sac and the anatomical status of the nerve roots coming from it. Compression in the spinal cord and nerve roots due to slippage is clearly evaluated with MRI.
What are the treatment options for spinal slip?
Treatment includes non-surgical treatment methods and surgical methods. They are collected under 2 headings: If there is only low back pain and no nerve root compression is detected, if there is no loss of strength in the leg or foot, and if no mobility is detected in direct x-rays of the lumbar vertebrae, then non-surgical treatment methods should be used. Non-surgical methods cannot repair mechanically damaged structures (cracked and/or shifted vertebrae), but they increase patients' participation in daily and business life through pain control. These methods are rest, painkillers or anti-inflammatory drugs, movement restriction program, corset and physical therapy applications. Controlling disease symptoms with non-surgical treatment methods will be possible in the future if the patient does not gain weight, learns how to perform daily activities without difficulty, and adopts this as a lifestyle. If pain cannot be controlled by the methods described above without loss of strength, consultation may be requested from physicians dealing with physical therapy and rehabilitation or algology (science of pain).
Pain that cannot be controlled with non-surgical treatment methods, strength in the legs and/or feet. Surgical treatment should be considered in patients with symptoms of urine loss, urinary and/or fecal incontinence. In this case, to relieve the nerve root under pressure, so-called decompression, that is, nerve root treatment, is performed. The process of removing the bone pressure on the patient should be done, and then the patient should be subjected to the fixation of the vertebrae, which the public calls platinum screw insertion, which we call fusion procedure in medicine. For desk workers, patients can return to work after 1 month. However, for patients who do physical work, a period of around 2 months is required. Some patients may need a physical medicine and rehabilitation program in the postoperative period.
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