Spondylolisthesis

The specific anamnesis is an important part of the diagnosis and of great significance for the subsequent therapy decision. Depending on the cause of the spondylolisthesis, the patient is asked about risk factors and the exact complaints: family history, sporting activity, previous operations or accidents, type, severity and occurrence of the complaints.

During the neurological examination, attention is paid to visible step formations in the continuity of the spinal column (skew phenomenon). Malpositions such as a hollow back (hyperlordosis), a tilting of the pelvis or scoliosis, which sometimes occur in pronounced forms of spondylolisthesis, can be signs of a protective posture of the patient in order to relieve affected nerve roots. Sensitivity, motor function and reflexes of the affected extremities are checked in order to exclude damage to the nerves. Provocation tests such as a compression of the spine or raising the upper body from a stooped position by supporting it with the hands on the thighs (climbing phenomenon) serve to estimate the severity of the disease.

Magnetic resonance imaging (MRI) is the radiological examination of choice for the diagnosis of spinal diseases and provides detailed information on intervertebral discs, ligaments and nerve structures. In particular, MRI can show compressions by the aforementioned structures on the nerve roots very well.

In addition, a computer tomography (CT) of the lumbar spine can be performed. It is also possible to visualize the nerve structures by injecting a contrast medium. This examination is called myelography or CT myelography. In addition, the quality of the bone and calcifications can be assessed much better in the CT than in the MRI.

The extent of spondylolisthesis is classified according to Meyerding grading. Spondyloptosis represents the most severe form of spondylolisthesis, in which the vertebral bodies have lost contact with each other and the upper vertebra tilts forward-downward.

How spondylolisthesis becomes symptomatic depends very much on the cause. Surgical intervention is always necessary when neurological deficits are present or conservative treatment has failed. The latter becomes noticeable through increasing load- and movement-dependent back and/or leg pain. It is not uncommon for spondylolisthesis to increase in the course of the disease.

The aim of the neurosurgical intervention is to gently relieve the nerve structures. Before the operation, it must first be clarified whether the patient's complaints and the findings in the imaging match. Then the indication for surgery is critically examined by the surgeon before a surgical procedure suitable for the patient is selected. In principle, three surgical goals should be pursued for spondylolisthesis: decompression, stabilization and reduction.

Decompression of the spinal canal and nerve roots under the microscope is a standard neurosurgical procedure. It is usually sufficient in degenerative spondylolisthesis, provided that no obvious instability can be demonstrated in the X-ray and clinically.

If clinical symptoms or imaging criteria are present in degenerative spondylolisthesis that indicate greater instability, stabilizing surgery such as spondylodesis is necessary so that the spine's load-bearing capacity can be restored. In other forms of spondylolisthesis (for example, spondylolysis, trauma, postoperative), spondylodesis is usually necessary to achieve a good long-term result.

The surgical techniques for stabilization are varied and are chosen according to the pathology and the surgeon's preference. Minimally invasive techniques are usually used. In some operations, especially when the spondylolisthesis is pronounced, open techniques are preferred in order to perform a safe reduction of the vertebral bodies under visual control of the nerves.

When stabilizing the vertebral bodies, the preservation or reconstruction of the natural spinal curvatures must be taken into account. The medical profession speaks of sagittal balance. Unnatural positions of the spinal segments can otherwise lead to overstraining of the muscle and ligament apparatus and thus to incorrect loading with further degeneration and pain.

On the first day after the operation, the patient is completely mobilized with the help of our physiotherapy specialists. He is also shown movements that relieve back strain. Only a few days after the operation, during which wound healing and neurological status are checked, the patient can be discharged. Depending on the severity of the neurological disorders, a rehabilitation program may follow or the patient may be discharged home. At regular intervals, of which the patient is informed upon discharge, a clinical and imaging check-up is carried out in our consulting room in order to monitor the healing process.