Spondylolisthesis corresponds to slippage of a vertebral body. A gap is therefore created between two vertebrae, causing a loss of alignment. The most affected vertebral levels are L4-L5 and L5-S1.
1) A LITTLE ANATOMY:
The lumbar region of the spine is made up of 5 vertebrae. The last lumbar vertebra articulates with the sacral bone.
Between these vertebrae, there are intervertebral discs in front, acting as a shock absorber, and joints behind, allowing movement between each level in flexion, extension and rotation.
In the center of these, the spinal cord passes and distributes nerve roots on each side, on each floor, which come out between each vertebra.
These roots travel from the neck to various parts of the upper limb and innervate the muscles, skin and joints along their route.
2) WHAT IS SPONDYLOLISTHESIS? WHAT ARE THE LESION MECHANISMS?
Spondylolisthesis (from the Greek spondylo: vertebra and listhesis: sliding) corresponds to the sliding of a vertebral body. A gap is therefore created between two vertebrae, causing a loss of alignment.
The most affected vertebral levels are L4-L5 and L5-S1.
There are two main injury mechanisms:
Degeneration: The body ages naturally, and so do the structures of the back. This wear can weaken the stabilizing elements and cause the vertebra to slip.
Isthmic lysis: part of the posterior arch of the vertebra, called the isthmus, is not fused. This can promote sliding of the vertebra.
This vertebral slippage leads to several problematic elements: overstraining of the posterior joints, increased stress on the disc, compression of the nerves, etc.
This can create painful symptoms in the lumbar region or in the lower limbs.
3) IS IT SERIOUS?
The level of severity of this pathology can vary. In order to determine it, a classification in four grades exists, grade 4 being the most severe. In mild cases, this pathology is sometimes asymptomatic at first.
If you experience symptoms similar to those mentioned above, it will be important to consult a doctor to determine the extent of the lesion and the resulting therapeutic choice.
These decisions will be made based on the interview, the clinical examination as well as the analysis of the medical imaging performed (MRI, X-ray, EMG, scanner, etc.).
Note that spondylolisthesis can sometimes go unnoticed on MRI or CT in the supine position. It is therefore interesting to take the shots in a standing position.
4) IS SURGERY MANDATORY?
The treatment proposal will not be similar in a young 20-year-old athlete or in an older sedentary patient. It will also depend on the grade of evolution of the pathology.
In less severe cases, conservative treatment is offered. It is based on medical and physiotherapy treatment.
On the other hand, in more serious cases, surgery may prove to be essential. This usually goes through a lumbar arthrodesis.
5) HOW DOES THE REHABILITATION TAKE PLACE?
Conservative and postoperative treatment have many similar points.
It will initially be based on medical aid (analgesics, anti-inflammatories), rest and physiotherapy. The latter will focus on different points:
Joint mobility recovery
Progressive global and specific muscle building
Education of the patient about his pathology and the potential risks of relapse
6) CAN I CONTINUE TRAINING?
If the diagnosis of spondylolisthesis does not represent a compelling reason for interrupting the sport, it must however be taken seriously from the start in order to avoid aggravations. The best option should be discussed with your doctor.
7) WHAT CAN I DO TO SPEED UP THE PROCESS?
In order to speed up the healing process, be sure to follow the recommendations of the health professionals with whom you work.
Laziness or, on the contrary, overzealousness, will be your enemies.
Conversely, discipline, rigor, perseverance as well as a positive and voluntary state of mind will help you get back in top shape as soon as possible!