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Spondylolisthesis in children
Last reviewed: 23.04.2024
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The diagnosis of spondylolisthesis (Latin spondylolisthesis, from the Greek spondylos - vertebra, listhesis - slippage) indicates the displacement of the vertebra anteriorly (in ICD-10 code M43.1).
The body of the lumbar vertebra V (L5) is most often displaced with respect to I sacral (S1) and IV lumbar (L4) to V lumbar vertebra (L5).
The displacement of the body of the vertebra to the side is called laterolistesis, and posteriorly to retrolistesis.
The prevalence of this pathology varies from 2 to 15%. In children and adolescents, grade I spondylolisthesis occurs in 79% of cases, grade II in 20% and grade III in 1% of patients.
[Causes of spondylolisthesis
Spondylolisthesis refers to multifactorial diseases, in the etiology and pathogenesis of which play the role of genetic and dysplastic components.
The development and progression of spondylolisthesis is due to the following factors:
- sagittal vertebral-pelvic imbalance;
- dysplasia of the lumbosacral spine (spina bifida, hypoplasia of the articular processes, hypoplasia of the transverse processes, hypoplasia of the arches of the vertebrae), high standing of the L5 vertebra with respect to the bispinal line;
- trapezoidal deformation of the body of the displaced vertebra and dome-shaped deformation of the upper surface of the body of the underlying vertebra;
- instability of the lumbosacral segment;
- the appearance and progression of degenerative changes in the intervertebral disc at the level of displacement.
Symptoms of spondylolisthesis
When spondylolisthesis patients complain of pain in the lumbosacral spine, often radiating to one of the lower limbs. There is a violation of posture or scoliotic deformation of the lumbar spine, weakness and hypotrophy in the lower limbs.
When examined, the trunk is shortened. It seems that the body is "pushed" into the pelvis. G.I. Turner called this body "telescopic". The sacrum occupies an upright position and appears prominently under the skin. The lumbar lordosis is strengthened and has an arcuate shape due to the displacement of the spine anteriorly. Because of truncation of the trunk above the crests of the iliac bones, folds are formed and the distance between the wings of the ileum and the lower ribs decreases.
Where does it hurt?
Diagnosis of spondylolisthesis
The diagnosis of spondylolisthesis in children is based on a set of anamnestic, clinical data, the results of radiation and physiological methods of investigation.
In the anamnesis, chronic trauma of the lumbosacral spine is noted. The formation of spondylolysis and spondylolisthesis is promoted by weightlifting, gymnastics, dancing, ballet, swimming.
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Treatment of spondylolisthesis
Conservative treatment is indicated in patients with grade 1 and 2 spondylolisthesis in the absence of a neurological deficit. Exclude the axial load on the spine. Prescribe NSAIDs (naproxen, diclofenac, ibuprofen), vitamins B, physiotherapy, exercise therapy, aimed at strengthening the long back muscles and anterior abdominal wall. When doing any physical work, we recommend wearing a semi-rigid corset. Indications for surgical treatment of spondylolisthesis:
- neurologic disorders of compression genesis on the background of stenosis of the spinal canal or chronic trauma of the spine:
- lumbulgia due to instability of the vertebral-motor segment;
- spondyloptosis;
- progressive displacement of the vertebra;
- inefficiency of conservative treatment for 6 months.
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