Lumbar Slippage (Spondylolisthesis) Treatment

Lumbar slippage, or spondylolisthesis, is a vertebra in the lower back that has slid forward over the one below it. The two main types are isthmic, from a stress fracture in a bony bridge (pars) that usually appears in adolescence, and degenerative, from worn facet joints and discs after age 50, typically at L4 to L5.

Many slips are found by chance and never cause trouble. Treatment is needed when the slip causes persistent back pain, or narrows the canal so that nerves are squeezed and walking distance shrinks.

Symptome

• Low back ache that worsens with standing and arching backwards
• Tight hamstrings and a stiff walking pattern, especially in teenagers
• Leg pain, heaviness or tingling that comes on with walking and eases on sitting or bending forward (neurogenic claudication)
• Sciatica from a pinched nerve root, usually L5
• A palpable step in the lower spine in higher grade slips
• Rarely, bladder or bowel disturbance

Ursachen und Risikofaktoren

In isthmic slippage, repeated hyperextension loads a thin part of the vertebral arch until it cracks; gymnasts, cricket fast bowlers, divers and weightlifters are typical. The crack may never heal, and the vertebral body can then drift forward, mostly during growth. In degenerative slippage the arch is intact, but arthritic facet joints and a worn disc no longer resist forward shear; it is several times more common in women. Less common causes are a congenital malformation of the lumbosacral joint, trauma, and removal of too much bone at previous surgery. Slips are graded 1 to 4 by how far the vertebra has moved, and most are grade 1 or 2.

Wie es diagnostiziert wird

• Standing lateral X-ray: Shows and grades the slip; lying films can miss it.
• Flexion and extension X-rays: Reveal abnormal movement, which influences the decision to fuse.
• MRI: Shows nerve compression, canal narrowing and disc condition.
• CT scan: Best for seeing a pars fracture and planning screws.
• Full spine standing films: Assess overall balance of the spine and pelvis before surgery for higher grades.

Behandlungsmöglichkeiten

• Activity modification and physiotherapy: Core stabilisation and hamstring stretching; the mainstay for most low grade slips.
• Bracing and rest from sport: For a fresh pars stress fracture in a young athlete, typically about 3 months, which can allow healing.
• Pain relief and epidural injection: For leg pain from nerve irritation; temporary benefit.
• Decompression alone: Removing bone and ligament pressing on nerves, for stable degenerative slips with mainly leg symptoms.
• Decompression with fusion: Pedicle screws and rods, usually with a cage between the vertebrae (TLIF or PLIF), when the segment is unstable or the slip is isthmic or high grade.
• Pars repair: Direct screw or hook repair of the crack in selected young patients with a healthy disc.

Wenn es dringend ist

Seek emergency care locally for new loss of bladder or bowel control, numbness in the saddle area, or rapidly progressing leg weakness. Severe back pain after a fall or accident, or back pain with fever, also needs same day assessment before any travel is considered.

Reisen nach Türkiye zur Behandlung

Conservative care belongs at home, as it runs over months. Travel makes sense for a surgical opinion with standing and bending X-rays and MRI, and for a planned decompression or fusion. For a fusion, plan 10 to 14 days in Istanbul, expect 3 to 5 nights in hospital, and arrange follow-up X-rays at home at about 6 weeks, 3 months and 1 year, because bony fusion takes 6 to 12 months to mature.

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