Dislocation of the lumbar vertebrae

Lumbar vertebral displacement or spondylolisthesis is a forward displacement of a vertebra due to congenital non-fusion of the vertebral arch with the body or due to degenerative changes in the intervertebral disc.

Displacement of the 5th lumbar vertebra is common, with this pathology a fracture of the vertebral pedicle occurs. In most cases, this disease is not hereditary, but acquired as a result of spinal injuries - gymnastics, football, wrestling, etc. A fracture received under such circumstances does not heal completely.

The displacement of the lumbar vertebrae can occur relative to the vertebra located below forward or backward. Accordingly, spondylolisthesis can be anterior or posterior. When the vertebrae are displaced, the facet joints do not hold the vertebra, and it slips, the intervertebral disc begins to stretch due to the constant load on it, which is why the overlying vertebra slips. The pathology may not remind of itself for many years, but with age, spondylolisthesis progresses, frequent pain in the back, its lower part occurs. Painful sensations with displacement of the vertebrae in the lower back appear after the age of 35.

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Causes of lumbar vertebrae displacement

The causes of displacement of the lumbar vertebrae are based on the following factors:

• history of spinal injuries (fractures, contusions, dislocations);
• degenerative changes in the spine in osteochondrosis;
• surgical interventions with impairment of the supporting function of the spinal column;
• disruption of the structure of the vertebral body, ligaments, intervertebral discs;
• previous car accidents, falls on the back;
• high physical exertion associated with lifting weights;
• age-related changes in the intervertebral joints, accompanied by stenosis of the spinal canal, pinched nerve roots, paralysis - the most common factors in the development of vertebral displacement in adulthood;
• congenital pathologies of the spine - non-closure of the vertebral arches, and this almost always leads to displacement of the vertebrae in the lumbar region;
• sudden temperature changes;
• sudden muscle contraction, prolonged muscle spasms in some diseases;
• uncomfortable working position; prolonged stay in a forced position.

If at least one cause is recorded in the anamnesis, it is worth visiting a doctor and, while the disease is not yet advanced, taking preventive measures and undergoing a course of manual therapy and physiotherapy.

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Symptoms of lumbar vertebrae displacement

Symptoms of lumbar vertebrae displacement do not appear immediately. Quite a bit of time (about several years) passes from the moment of injury and displacement development to the appearance of the first persistent pain sensations, and this negatively affects diagnostics and prevents timely effective treatment.

In general, the symptoms depend on where the spine is damaged. When the lumbar region is displaced, the joint process is fractured first, and then the spinal disc is displaced, all this causes pain in the legs, lameness, which prevents full movement. There are frequent cases of chronic pain syndrome in the lumbar region, impaired sensitivity below the site of spinal injury. Reflexes may be weakened - knee and Achilles. The main symptom of lumbar vertebrae displacement is practically non-analgesic pain in the lower back.

General changes that occur with displacement:

• weakness;
• chronic dysfunction of internal organs;
• change in posture, gait;
• the appearance of osteochondrosis, intervertebral hernias;
• radiculopathy, numbness of the lower limbs, pain in the knees, ankles, swelling in the legs.

Displacement of the 5th lumbar vertebra

Displacement of the 5th lumbar vertebra is quite common in medical practice. The fact is that the articulation of the fifth vertebra with the sacrum is the most vulnerable part of the spine. In 50% of cases, an intervertebral hernia occurs between the 4th and 5th lumbar vertebrae or between the 5th vertebra and the sacrum. The process of disc displacement occurs gradually, 5 stages of pathology development are distinguished:

1. Prolapse. The disc is minimally displaced, approximately no more than 2 mm, the nucleus is within the vertebral body.
2. Protrusion. The disc is displaced no more than 1.5 cm, the nucleus is within the vertebral body.
3. Extrusion. The nucleus is displaced outward, beyond the vertebral body.
4. Sequestration. The nucleus hangs down like a drop, the fibrous ring ruptures and the nuclear material flows out.

When a vertebra is displaced, there is very severe pain in the lumbar region, sacrum, coccyx, and lower extremities. The localization of pain depends on where the spine is damaged, the extent of the damage, and the age of the patient. Adults are bothered by pain in the lumbar region and lateral surfaces of the pelvis. In children and adolescents, pain occurs in the lower extremities - knees, ankles.

At the first stage of the disease, lower back pain is felt in a sitting position and when bending. At the second stage, the pain is constant and intensifies with movement and physical activity. At the third stage, changes in posture are noticeable - the pelvis sags, motor activity is limited. At the fourth-fifth stage, the gait changes - the legs are bent at the knees, the chest and stomach protrude forward.

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Diagnosis of lumbar vertebral displacement

Diagnosis of lumbar vertebral displacement is based on X-ray, computed tomography or magnetic resonance imaging data. Often, an X-ray of the lumbar spine is sufficient to make an accurate diagnosis.

The diagnosis of spondylolisthesis or vertebral displacement does not mean that this is the cause of lower back pain. There may be other causes of pain - intervertebral hernia, tumors, etc. In order to establish an accurate diagnosis and prescribe effective treatment, it is necessary to identify the connection between the pain syndrome and the displacement of the vertebrae in the lumbar region and exclude other possible causes of back pain.

To clarify the diagnosis, it is important to describe in detail the complaints, the pattern of pain occurrence, indicate the presence of possible injuries or harmful factors. During the conversation with the doctor, it is important to answer the following questions as informatively as possible:

1. When does back pain appear? How long has it been bothering you?
2. What is the nature of the pain? Intensity, localization, relationship with motor activity.
3. Are you bothered by numbness in your limbs or weakness?
4. Is there any dysfunction of the pelvic organs? (problems with urination, defecation).

After the survey, the doctor examines the patient, palpates the area of pain localization, checks tendon reflexes, skin sensitivity, muscle strength, and symptoms of nerve root tension.

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Treatment of lumbar vertebral displacement

Treatment of lumbar vertebral displacement can be surgical or conservative.

Conservative treatment of vertebral displacement

The principle is to treat pain caused by spinal pathology or compression of nerve roots. Conservative treatment is quite effective in many cases and includes:

• Nonsteroidal anti-inflammatory drugs.
• Oral administration of steroid drugs is indicated.
• Physiotherapy on the affected area (thermal procedures, warming up).
• Manual therapy (massage).
• Injections of drugs into the epidural area.

Treatment is also aimed at strengthening the back and abdominal muscles, this is necessary to eliminate instability of the spinal column. If the pain is too strong and frequent, drug therapy is prescribed - non-steroidal and steroidal anti-inflammatory drugs. Non-steroidal anti-inflammatory drugs are drugs that have an analgesic, antipyretic and anti-inflammatory effect, such as diclofenac, ibuprofen, butadion, dimexide.

Diclofenac is prescribed to adults in a dose of 25-50 mg 2-3 times a day, but the frequency of administration may vary depending on the severity of the disease. When taken externally, Diclofenac in the form of an ointment is applied to the affected area at 2-4 g 3-4 times a day. The daily dose should not exceed 2 mg/kg.

Possible gastrointestinal disorders in the form of nausea, vomiting, anorexia, stomach pain, flatulence, constipation, diarrhea, rarely - liver dysfunction, with rectal use, inflammation of the colon, bleeding is possible.

From the central nervous system side the following may be observed: dizziness, headache, agitation, insomnia, irritability, feeling of fatigue, in rare cases - paresthesia, visual disturbances, tinnitus, sleep disorders, convulsions, irritability, tremor, mental disorders, depression.

Adults are prescribed Ibuprofen in a dose of 400-600 mg 3-4 times a day. When taking it, it is necessary to monitor the blood picture, the state of the liver and kidneys, and in case of gastrointestinal disorders, pain in the epigastrium, esophagogastroduodenoscopy, blood test to determine Hb, hematocrit, stool test for occult blood are indicated. To prevent the development of gastropathy, it is recommended to combine with PgE drugs (misoprostol). Alcohol intake is completely contraindicated during the course of treatment with Ibuprofen, and it is also necessary to refrain from all types of activities that require increased attention, quick mental and motor reactions.

The drug is contraindicated in case of hypersensitivity, gastric ulcer and duodenal ulcer in the acute stage, ulcerative colitis, peptic ulcer, Crohn's disease - non-specific ulcerative colitis), "aspirin" asthma, blood clotting disorders (including hemophilia, prolongation of bleeding time, tendency to bleeding, hemorrhagic diathesis), pregnancy, lactation. Cirrhosis, hyperbilirubinemia, gastric ulcer and duodenal ulcer (in anamnesis), gastritis, enteritis, colitis; liver and / or kidney failure, nephrotic syndrome; CHF, arterial hypertension; blood disease of unknown etiology, childhood (for tablet forms - up to 12 years, 6 months - for oral suspension). Children 6-12 months are prescribed only on the recommendation of a doctor.

Dimexide is prescribed for local anesthesia, in the form of a 25-50% solution of the drug for compresses of 100-150 ml 2-3 times a day. Dimexide is tolerated without complications, but erythema, itching, dizziness, insomnia, adynamia, dermatitis, diarrhea may occur. In severe cases, nausea, vomiting, bronchospasm are observed.

Dimexide is contraindicated in cases of severe cardiovascular insufficiency and atherosclerosis, angina pectoris, renal and hepatic dysfunction, stroke, comatose states, pregnancy, breastfeeding, glaucoma, cataracts. It is prescribed with caution to elderly people. Contraindicated for children under 12 years of age, during pregnancy and breastfeeding.

Steroid anti-inflammatory drugs are prescribed in particularly severe forms of the disease, these include: cortisone, hydrocortisone, prednisolone, dexamethasone, triamcinolone.

Dexamethasone is dosed depending on the severity of the disease, the drug is prescribed both orally and in the form of injections, but strictly according to the doctor's prescription. Before starting to take Dexamethasone, you need to do a blood test to control the amount of sugar and electrolytes. Dexamethasone is contraindicated for pregnant and lactating women.

When taking the drug, immunity decreases, so it should be taken in combination with immunoglobulins, and also limit contact with infectious patients. It is also better not to combine Dexamethasone with other drugs - this can reduce the effectiveness of one of the drugs.

Cortisone is administered orally or intramuscularly (as a suspension - a suspension of solid particles of the drug in a liquid). Orally, it is taken in the first days of treatment at 0.1-0.2 g per day (in 3-4 doses), then the dose is gradually reduced to 0.025 g per day. The course dose is 3-4 g. The highest single dose of cortisone for adults is 0.15 g, daily - 0.3 g.

With long-term treatment and the use of large doses (more than 0.1 g per day), obesity, hirsutism (excessive hair growth in women, manifested by the growth of a beard, moustache, etc.), acne, menstrual irregularities, osteoporosis, Itsenko-Cushing's syndrome, mental disorders, etc. may develop. Ulceration of the digestive tract is also possible.

Cortisone is contraindicated in severe hypertension (persistent increase in blood pressure), diabetes mellitus, Itsenko-Cushing's disease, pregnancy, stage III circulatory failure, peptic ulcer, recent surgery, syphilis, active tuberculosis, and old age.

Also, in the non-acute phase of spondylolisthesis, folk treatment is effective - ointments, compresses, baths.

• Apply an ointment based on 50 g of mustard powder, camphor, two eggs, and 20 g of alcohol. Apply the ointment to the affected area for 2 hours, then remove the remaining ointment by wiping the affected area dry. After the procedure, the affected area should be warmly wrapped.
• To relieve inflammation and pain, prepare the following mixture: 2 cups of honey, 2 cups of grated radish and 0.5 cups of vodka. Mix all ingredients well and use as a rub.
• You can also use mumiyo - in the form of ointments, rubs, orally in the form of tablets. You can buy mumiyo at the pharmacy.
• In case of spondylolisthesis, it is useful to make baths based on mint. It is better to collect mint during the flowering period, then boil it in a bucket, let it brew and pour it into the bath, you can dilute it a little with ordinary water. The bath should be taken before the water cools down. After the bath, the sore spot should be rubbed well and put on warm clothes, wrap yourself up. Baths are contraindicated in case of severe diseases of the heart, blood vessels, mental disorders.

Physiotherapy can rightfully be considered an important component of spondylolisthesis treatment. Physiotherapy treatment can be divided into two types - active and passive.

Passive treatment includes:

• Deep back muscle massage.
• Thermal therapy is the application of heat or cold to the affected area to improve blood circulation.
• Electrophoresis of the affected area for the purpose of electrical stimulation of the nerve roots.
• Ultrasound treatment or ultraphonotherapy helps reduce muscle spasms, cramps, swelling, stiffness and pain. Sound waves penetrate deep into the muscles, creating heat, which improves blood circulation and speeds up the healing process.

Active treatment includes developing an individual set of exercises to strengthen the muscular corset, which helps maintain the spine in the correct position and improves posture. In case of acute pain, wearing a corset is indicated, but it should be taken into account that wearing a corset for a long time is contraindicated, otherwise the back muscles will begin to weaken, and this will only aggravate the course of the disease.

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Surgical treatment of lumbar vertebral displacement

An extreme measure, indicated in the absence of improvement during conservative therapy. The essence of the operation is to ensure the stability of the spinal column and reduce the compression of the nerve branches. Quite effective is the method of vertebral plastic surgery, when an element of the iliac crest is used for restoration, which is then attached to the overlying vertebra with special pins. If there is a manifestation of compression of the nerve roots, then a laminectomy is additionally performed in order to solve the problem of vertebral displacement and compression of the spinal cord, nerve roots, and removal of the spinal arch is indicated. Excess scar tissue that compresses the nerves and causes pain is removed. Then the actual stabilization of the spinal column is carried out, aimed at restoring the spinal motor department.

Advice for patients with lumbar vertebrae displacement is reduced to minimizing the load on the lumbar spine. This includes the correct sleeping position, best on the side and with legs pulled up, the bed should be flat, for example, with a foam rubber mattress (6-8 centimeters thick).

During the acute period, it is necessary to provide the spine with maximum rest - no loads, massage, physiotherapy, periodic wearing of an elastic corset is recommended. After significant relief, you can begin therapeutic exercise, namely stretching the spinal column and strengthening the abdominal and back muscles.

Gymnastics for displacement of lumbar vertebrae

Gymnastics for lumbar vertebrae displacement is an element of the complex of conservative treatment of vertebrae displacement. In combination with wearing orthopedic corsets, medicinal symptomatic treatment, exercise therapy plays an important role.

It is impossible to completely cure the displacement of the lumbar vertebrae with the help of a set of exercise therapy exercises, but it is quite possible to control the stability of the spinal column. The main task is to develop an individual set of therapeutic and gymnastic exercises aimed at strengthening the deep muscles of the back and abdominal muscles. When the vertebrae are displaced, there is a decrease in the tone of the paravertebral muscles, and their strengthening is the best way to form a muscular corset and maintain the spinal column in the correct position.

When composing an individual set of exercises, the doctor takes into account the degree of neglect of the disease, the degree of displacement of the vertebra, the age of the patient. Degenerative changes are observed mainly in elderly people, over 60 years old. Dysplastic and isthmic displacement of the vertebrae is more common in childhood and in young patients-athletes. Accordingly, this will fundamentally affect the composition of the therapeutic set of exercises.

Exercises for lumbar vertebrae displacement

Exercises for lumbar vertebrae displacement are developed strictly individually, taking into account the degree of disease progression, the nature of degenerative changes, and the patient's age. For example, degenerative changes in the spine manifest themselves in old age, while dysplastic and isthmic changes are observed in children and young athletes. This will largely affect the formation of an effective set of exercises.

Despite the specifics of the exercise complex itself, there are conditions for its implementation:

1. You need to start doing the complex in a lying position. You can lie on your back, stomach, side, or even stand on all fours. This allows you to completely unload the spine and reduce pressure in the affected area.
2. At the early stage of the disease, exercises are aimed at relaxing the muscles of the body and limbs. Removing the spasm relieves the compression of the nerve roots.
3. During the acute stage, as well as the subacute stage, exercises cannot be done.
4. Exercises that require bending the body more than 15-20 degrees should not be performed. This provokes an increase in intravascular pressure, displacement of discs, stretching of fibrous tissues, muscle tissues of the lumbar region. In a state of unstable remission, these exercises are also contraindicated.
5. Good results are achieved by exercises aimed at stretching the spinal column. This leads to an increase in the intervertebral spaces, the diameter of the intervertebral openings, which relieves the compression of the spinal nerve roots.

To stabilize the affected area of the spine, strengthen the muscles of the body, pelvis and limbs, static exercises are acceptable. With a mild degree of damage, you can gradually give a higher load, performing isotonic exercises. This complex helps to eliminate hypertonicity of blood vessels in the affected area. With severe damage to the spine, isometric exercises with gradual muscle relaxation are indicated.

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Prevention of lumbar vertebral displacement

Prevention of lumbar vertebral displacement is aimed at preventive measures against degenerative and isthmic displacement. To do this, you need to lead a healthy lifestyle and move around a lot.

1. It is important to work correctly at a desk. You need to sit up straight, without bending your head and upper body forward, so you can regulate the load on your muscles and not overstrain them. The seat of the chair should be at knee level, and your knees should be bent to the floor at a right angle. To avoid too much pressure on the back of your thighs, you can put a low stool under your feet.
2. If your work involves standing for long periods of time, you need to change your position every 10 minutes to avoid redistributing the load on your spine and overexerting your muscles.
3. When doing housework, the load should be transferred from the lower back to the legs.
4. You should not carry too heavy a load at one time. Any load, if possible, is better divided into parts. It is better to carry heavy loads with both hands, holding them close to the body. This way the load will move from the back to the shoulder girdle and arms. For long distances, it is best to carry the load in a backpack.
5. Gardening work is best done kneeling or sitting on a bench. The smaller the degree of deflection, the less load on the spine. When lifting a load, do not allow the body to turn - this can provoke disc prolapse.
6. You need to sleep on a semi-soft bed, the pillow should occupy the space between the shoulder and neck, and the head should be parallel to the bed. You can't sleep on a bolster - this leads to compression of blood vessels and can provoke a stroke.
7. It is important to do special exercises that strengthen the back and abdominal muscles.
8. It is useful to use special belts and corsets, but you should not do this too often - muscle tone decreases and this leads to deformation of the spine and prolapse of vertebrae.

Lumbar vertebral displacement prognosis

The prognosis for lumbar vertebral displacement is generally favorable and does not pose a threat to the patient's life. In particular, with timely treatment and conservative treatment, the effect occurs fairly quickly and surgical intervention is not required. If the patient's condition is severe and the disease is recorded at an advanced stage, only then are measures taken for urgent surgical intervention. Depending on the nature of the injury, various types of operations are performed - they remove excess scar tissue that compresses the roots of the spinal nerves, remove the arch of the broken vertebra and perform canal plastic surgery. In some cases, fusion of the vertebrae is indicated, this provides more space for the location of the roots of the nerve endings and relieves pain in the lower back and legs.

At a young age, the disease can be eliminated with full subsequent restoration of working capacity, but at an old age, it is very difficult to restore working capacity, the patient is given a disability group. The cause is concomitant degenerative changes in the internal organs, arthritis, radiculitis, etc. Also, the timeliness of seeking help and compliance with all conditions of conservative and surgical treatment are of great importance.

A patient with a recorded and confirmed diagnosis of lumbar vertebral displacement is registered for dispensary observation for 3 years or more, depending on the dynamics of the disease. Preventive examinations are indicated, recorded by X-ray data of the affected spine.

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