Displacement of lumbar vertebrae

Displacement of the vertebrae of the lumbar spine or spondylolisthesis is the displacement of the vertebra forward in congenital non-growth of the vertebral arch with the body or with degenerative changes in the intervertebral disc.

Often there is a displacement of the 5th lumbar vertebra, with this pathology a fracture of the vertebral pedicle occurs. In the majority this disease is not hereditary, but acquired as a result of spinal injuries - gymnastics, football, wrestling, etc., a fracture obtained under such circumstances is completely not fused.

The displacement of the vertebrae of the lumbar region can occur with respect to the underlying vertebra located forward or backward. Accordingly, spondylolisthesis can be either anterior or posterior. When the vertebrae are displaced, the facet joints do not hold the vertebra, and it slides, the intervertebral disc begins to stretch because of the constant load on it, which causes the overlying vertebra to slip out. Pathology for many years may not remind you of itself, but with age, spondylolisthesis progresses, there are frequent pain in the back, its lower part. Painful sensations at displacement of vertebrae in a loin are shown after 35-year-old age.

[1], [2], [3]

Causes of lumbar vertebrae displacement

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

• spinal trauma in the anamnesis (fractures, bruises, dislocations); 
• degenerative changes of the spine with osteochondrosis; 
• operative interventions with violation of the supporting function of the spinal column; 
• disruption of the structure of the vertebral body, ligaments, intervertebral discs; 
• Car crashes suffered, falls on the back; 
• high physical loads associated with lifting weights; 
• age changes in the intervertebral joints, accompanied by stenosis of the spinal canal, jamming of the nerve roots, paralysis - the most common factors in the development of vertebral dislocation in adulthood; 
• congenital abnormalities of the vertebral column - nevorozhchenie arches vertebra, and this almost always leads to the displacement of the vertebrae in the lumbar region; 
• sharp temperature changes; 
• a sharp muscle contraction, prolonged muscle spasms in certain diseases; 
• uncomfortable working position for a long time in a forced position.

If there is at least one cause in the history, it is worthwhile to visit the doctor and until the disease is started, take preventive measures and undergo a course of manual therapy and physiotherapy.

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Symptoms of lumbar vertebrae displacement

Symptoms of displacement of the lumbar vertebrae are not immediately apparent. From the time of injury and the development of displacement to the appearance of the first persistent pain, a lot of time passes (about several years), and this negatively affects the diagnosis and prevents timely effective treatment.

In general, the symptoms depend on where the spine is damaged. When you move in the lumbar region, the joint is first fractured, and then the spinal disc is displaced, all this causes pain in the legs, lameness, which impedes full movement. There are often cases of chronic pain syndrome in the lumbar region, a violation of sensitivity below the site of spinal injury. It is possible to weaken the manifestation of reflexes - knee and Achilles. The main symptom for the displacement of the lumbar vertebrae is practically not anesthetized pain in the lower back. 

General changes that occur when you move: 

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

Displacement of the 5th lumbar vertebra

Displacement of the 5 vertebra of the lumbar region in medical practice is often enough. 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, the intervertebral hernia occurs between the 4th and 5th lumbar vertebrae or between the 5th vertebra and the sacrum. The process of displacement of the disk occurs gradually, there are 5 stages of pathology development: 

1. Prolapse. The disk is displaced minimally, approximately no more than 2 mm, the core is within the vertebral body. 
2. Protrusion. The disc is displaced no more than 1.5 cm, the core is within the body of the vertebra. 
3. Extrusion. The nucleus is displaced outside, beyond the vertebral body. 
4. Sequestration. The nucleus dangles in the form of a drop, the fibrous ring breaks and the core material flows out.

When the vertebra is displaced, a very strong pain in the region of the waist, sacrum, coccyx, in the lower limbs is disturbed. The localization of pain depends on where the spine is injured, the degree of damage and the age of the patient. Adults are concerned about back pain, lateral surfaces of the pelvis. In children and adolescents, pain occurs in the lower limbs - knees, ankles.

At the first degree of the disease, low back pain is disturbed in a sitting position and with inclinations. At the second degree the pain is constant, amplified by movement and physical load. At the third degree, changes in posture are noticeable - the pelvis sags, motor activity is limited. At the fourth-fifth degree the gait changes - the legs are bent at the knees, the thorax, the stomach bulge forward.

[5], [6], [7],

Diagnosis of displacement of lumbar vertebrae

Diagnosis of displacement of lumbar vertebrae is based on radiography, computed tomography or magnetic resonance imaging. Often, in order to make an accurate diagnosis, it is enough to have an X-ray image of the lumbar region.

The diagnosis of spondylolisthesis or displacement of the vertebrae does not mean that this is the cause of low back pain. The causes of pain may be others - the intervertebral hernia, tumors, etc. In order to establish an accurate diagnosis and prescribe an effective treatment, you need to link the pain syndrome with 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 picture of the occurrence of pain, 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 there are pains in the back? How long have you been bothered? 
2. What is the nature of the pain? Intensity, localization, connection with motor activity. 
3. Concerns about numbness of limbs, weakness? 
4. Is there a violation of the pelvic organs? (problems with urination, defecation).

After the interview, the doctor conducts an examination of the patient, palpation of the area of pain localization, testing of tendon reflexes, sensitivity of the skin, muscle strength, nerve root tension symptoms.

[8], [9], [10], [11], [12]

Treatment of lumbar vertebrae displacement

Treatment for the displacement of the lumbar vertebrae can be surgical or conservative. 

Conservative treatment of vertebral displacement

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

• Non-steroidal anti-inflammatory. 
• Oral reception of steroid preparations is indicated. 
• Physiotherapy on the affected area (thermal procedures, warming up). 
• Manual therapy (massage). 
• Injection of drugs in the epidural region.

The treatment is also aimed at strengthening the dorsal and abdominal muscles, this is necessary in order to eliminate the instability of the spinal column. If the pains are too strong and frequent, drug therapy is prescribed - non-steroidal and steroidal anti-inflammatory drugs. Non-steroidal anti-inflammatory drugs are medicines that have analgesic, antipyretic and anti-inflammatory effect, for example diclofenac, ibuprofen, butadione, dimexide.

Diclofenac adults are prescribed in a dose of 25-50 mg 2-3 times / day, but the frequency of admission can vary depending on the severity of the disease. At external reception Diclofenac in the form of ointment put on the amazed zone on 2-4 g 3-4 times / day. The daily dose should not exceed 2 mg / kg.

Possible abnormalities of the gastrointestinal tract in the form of nausea, vomiting, anorexia, stomach pain, flatulence, constipation, diarrhea, rarely - violations of liver function, rectal use may cause inflammation of the colon, bleeding.

From the side of the central nervous system can be observed: dizziness, headache, agitation, insomnia, irritability, a feeling of fatigue, in rare cases - paresthesia, visual impairment, tinnitus, sleep disorders, cramps, irritability, tremor, mental disorders, depression.

Ibuprofen adults are prescribed in a dose of 400-600 mg 3-4 times a day. At admission, it is necessary to keep a picture of blood, liver and kidneys under control, and if there are abnormalities in the work of the digestive tract, epigastric pain shows esophagogastroduodenoscopy, a blood test with the determination of Hb, hematocrit, analysis of feces for latent blood. To prevent the development of gastropathy it is recommended to combine with PgE (misoprostol) preparations. The use of alcohol for the duration of the course of treatment with Ibuprofen is completely contraindicated, and it is also necessary to refrain from all activities requiring increased attention, rapid mental and motor reaction.

The drug is contraindicated in hypersensitivity, peptic ulcer and duodenal ulcer in the stage of exacerbation, ulcerative colitis, peptic ulcer, Crohn's disease - ulcerative colitis), "aspirin" asthma, blood clotting disorders (including hemophilia, bleeding time elongation , propensity to bleed, hemorrhagic diathesis), pregnancy, lactation. Cirrhosis, hyperbilirubinemia, peptic ulcer and 12 duodenal ulcer (in the anamnesis), gastritis, enteritis, colitis; hepatic and / or renal failure, nephrotic syndrome; CHF, arterial hypertension; blood disease of unclear etiology, childhood (for tableted forms - up to 12 years, 6 months - for a suspension for oral administration). Children 6-12 months are prescribed only on the advice of a doctor.

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

Dimexide is contraindicated in severe cardiovascular insufficiency and atherosclerosis, stenocardia, violations of kidney and liver function, stroke, coma, during pregnancy, during breastfeeding, glaucoma, cataracts. With caution appoint elderly people. Contraindicated in children under 12 years of age, with pregnancy and lactation.

Steroidal anti-inflammatory drugs are prescribed in especially severe forms of the disease, they include: cortisone, hydrocortisone, prednisolone, dexamethasone, triamcinolone.

Dexamethasone is dosed depending on the complexity of the course of the disease, the drug is administered either orally, and in the form of injections, but strictly according to the doctor's prescription. Before you start taking Dexamethasone, you need to do a blood test in order to check the amount of sugar and electrolytes. Dexamethasone is contraindicated in pregnant and lactating women.

When taking the drug, immunity decreases, so you need to take it in combination with immunoglobulins, and also limit communication 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 the liquid). Orally take in the first days of treatment for 0.1-0.2 g per day (3-4 times), 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 treatment and the use of large doses (more than 0.1 g per day), the development of obesity, hirsutism (excessive hair loss in women, manifested by the growth of beard, mustache, etc.), acne, menstrual cycle disorders, osteoporosis, symptomatic complex Itenko- Cushing, mental disorders, etc. Ulcerations of the digestive tract are also possible.

Cortisone is contraindicated in hypertensive disease with severe current (persistent elevation of blood pressure), diabetes mellitus, Itzenko-Cushing's disease, pregnancy, circulatory failure III stage, peptic ulcer disease, recently transferred operations, syphilis, active form of tuberculosis, senile age.

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

• Apply ointment on the basis of 50 g. Mustard powder, camphor, two eggs, and 20 gr. Alcohol. Ointment is applied to the affected area for 2 hours, then the remnants of the ointment are removed, wiping the affected area to dryness. After the procedure, the sick zone should be warmly wrapped. 
• To remove the inflammation and pain, the following composition is prepared: 2 cups of honey, 2 cups of grated radish and 0.5 glasses of vodka. All components are well mixed and used as rubbing. 
• You can also use mummy - in the form of ointments, sweets, orally in the form of tablets. You can buy a mummy at the pharmacy. 
• With spondylolisthesis it is useful to make baths based on mint. Mint is better to collect during the flowering period, then boil in a bucket, let it brew and pour into the bath, you can dilute it with plain water. The bath should be taken before cooling water. After the bath, the sore spot needs to be grinded well and put on warm underwear, wrapped around. Baths are contraindicated in cases of severe heart disease, blood vessels, mental disorders.

An important component of the treatment of spondylolistosis is physiotherapy. Physiotherapeutic treatment can be divided into two types - active and passive.

Passive treatment includes: 

• Massage of deep muscles of the back. 
• Temperature treatment - the effect of heat or cold on the affected area in order to improve blood circulation. 
• Electrophoresis on the affected area for the purpose of electrical stimulation of the nerve roots. 
• Ultrasound treatment or ultraphonotherapy helps reduce muscular spasms, cramps, swelling, stiffness and pain. Sound waves, penetrating deep muscles, create heat, which improves blood circulation and speeds up the healing process.

Active treatment includes the development of an individual set of exercises to strengthen the muscular corset, which helps maintain the spine in the right position, and also improves posture. When acute pain is shown wearing a corset, but you need to take into account that wearing a corset for a long time is contraindicated, otherwise the dorsal muscles will begin to weaken, and this will only exacerbate the course of the disease.

[13], [14], [15], [16], [17],

Surgical treatment of lumbar vertebrae displacement

The extreme measure is indicated in the absence of improvement during conservative therapy. The essence of the operation in the implementation of the stability of the spinal column and a decrease in the compression of the nerve branches. The vertebral plastic method is quite effective when the element of the iliac crest is used for restoration, which is then attached to the overlying vertebra by special pins. If there is a manifestation of compression of the roots of the nerves, then additionally a laminectomy is performed in order to solve the problem of displacement of the vertebra and compression of the spinal cord, nerve roots, and removal of the vertebral arch is indicated. Removed excess scar tissue, which squeezes nerves and causes pain. Further, the stabilization of the vertebral column itself is carried out, aimed at restoring the spine and motor department.

Advice to patients with a shift of the lumbar vertebrae is reduced to minimizing the load on the lumbar spine. This is the correct posture of sleep, best on the side and with tight legs, the bed should be flat, for example, with a foam mat (6-8 centimeters thick) mattress.

In the acute period, you need to provide the spine with maximum rest - no stress, massage, physiotherapy, shows the occasional wearing of an elastic corset. After considerable relief, it is possible to start physical therapy, namely stretching the spine and strengthening the abdominal and spinal muscles.

Gymnastics with the displacement of the vertebrae of the lumbar region

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

Completely cure the displacement of the lumbar vertebrae with the help of complex exercise therapy is impossible, but it is quite possible to monitor the stability of the spinal column. The main task is to develop an individual complex of therapeutic and gymnastic exercises aimed at strengthening the deep muscles of the back and the abdominal press. With the displacement of the vertebrae, there is a decrease in the tone of the paravertebral muscles, and their strengthening is the best way to build a muscle corset and maintain the spine in the correct position.

By 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 the age of 60. Dysplastic and isthmic displacement of vertebrae occurs more often in childhood and in young athlete patients. Accordingly, this will fundamentally affect the composition of the therapeutic complex of exercises.

Exercises for the displacement of the vertebrae of the lumbar region

Exercises for the displacement of the vertebrae of the lumbar region are developed strictly individually, taking into account the degree of progression of the disease, the nature of degenerative changes, the age of the patient. For example, a degenerative change in the spine is manifested in the elderly, and 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 peculiarities of the complex of exercises, there are the conditions for implementation: 

1. Start the implementation of the complex in prone position. You can lie on your back, stomach, on your side, it is permissible to stand on all fours. This allows to completely relieve the spine and reduce the pressure in the affected area. 
2. At an early stage of the disease, exercises are aimed at relaxing the muscles of the body, limbs. The removal of the spasm relieves the squeezing of the nerve roots. 
3. In the stage of exacerbation, in the subacute stage of the exercise, one can not do either. 
4. You can not do exercises that require the torso to tilt more than 15-20 degrees. This provokes an increase in intravascular pressure, disc displacement, stretching of fibrous tissues, muscle tissue of the lumbar region. In the state of unstable remission, these exercises are also contraindicated. 
5. A good result is given 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 roots of the vertebral nerves.

To stabilize the affected area of the spine, strengthen the muscles of the body, pelvis and extremities are acceptable static exercises. With a mild degree of lesion, you can gradually give a higher load, performing isotonic exercises. This complex helps to eliminate the hypertension of the vessels in the affected area. In severe spinal injury, isometric exercises are shown with a gradual relaxation of the muscles.

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Prevention of lumbar vertebrae displacement

Prevention of displacement of the lumbar vertebrae is aimed at preventive measures with respect to the degenerative and isthmic displacement. To do this, you need to lead a healthy lifestyle and move a lot. 

1. It is important to work properly at your desk. Sitting right, without bending the head and upper body forward, so you can adjust the load on the muscles and not overtax them. The seat of the chair should be at the level of the knees, and the knees should be bent to the floor at a right angle. In order not to put too much pressure on the back of the thighs, you can put a low bench under the feet. 
2. If the work is associated with a long standing, then you need to change your posture every 10 minutes, so as not to redistribute the load on the spine and not overwork your muscles. 
3. Doing homework, the load from the waist needs to be carried to the feet. 
4. Do not carry too heavy a burden at one time. Any cargo, if possible, is better divided into parts. It is better to carry weights with both hands, keeping closer to the body. So the load from the back will move to the shoulder girdle and hands. For long distances it is best to carry the load in a backpack. 
5. Garden work is best done standing on your knees or sitting on a bench. The smaller the degree of deflection, the less the strain on the spine. Lifting the load can not be allowed to rotate the trunk - this can provoke the fall of the discs. 
6. Sleep should be on a semi-soft bed, the pillow should occupy the space between the shoulder and neck, and the head was parallel to the bed. It is impossible to sleep on the platen - this leads to squeezing of the vessels and can provoke a stroke. 
7. It is important to perform special exercises that strengthen the muscles of the back and abdominal press. 
8. Using special belts and corsets is useful, but doing it too often is not worth it - the muscle tone decreases and this leads to deformation of the spine and prolapse of the vertebrae.

Forecast of displacement of lumbar vertebrae

The prognosis of the displacement of the lumbar vertebrae is generally favorable and does not lead to a threat to the life of the patient. In particular, with timely access to a doctor and the appointment of conservative treatment, the effect occurs soon enough and no surgical intervention is required. If the patient's condition is severe, and the disease is fixed in an advanced stage, then only urgent measures are taken. Depending on the nature of the damage, various types of operations are performed - remove excess scar tissue, squeeze the roots of the vertebral nerves, remove the arc of the fractured vertebra and conduct the plasty of the canal. In some cases, fusion of the vertebrae is shown, this gives more space for the placement of roots of nerve endings and facilitates pain in the lower back and legs.

At a young age, the disease can be eliminated with complete further restoration of work capacity, and in the old age it is very difficult to restore work ability, the patient is given a disability group. The cause is associated with degenerative changes in the internal organs, arthritis, sciatica, etc. Also of great importance is the timeliness of seeking help and adherence to all conditions of conservative and surgical treatment.

The patient, with a fixed and confirmed diagnosis of the displacement of the lumbar vertebrae, is recorded on a dispensary record for 3 years or more, depending on the course of the course of the disease. Preventive examinations, recorded by X-ray of the affected spine, are shown.

[19], [20], [21], [22]