Spondylolisthesis

Spondylolisthesis is a common condition of the spine, which can occur at a young age although it often ends up being treated after the age of 40. It is a condition, which, if neglected, carries the risk of partial paralysis.

Spondylolisthesis is the displacement (slipping) of one vertebra over another. As a result, the lumen, which forms at the back of the vertebrae, narrows dramatically at the point of slipping, resulting in pressure on the nerves and causing spinal stenosis.

Spondylolisthesis can occur as early as adolescence, but most patients get to the point where they do something about their problem much later, between the ages of 40 and 50.

It is a cause of back pain and narrowing with a very specific anatomical feature, which usually needs further intervention.

Yes. The most characteristic form of spondylolisthesis is that due to a small break in a critical area of the vertebra, which creates this instability and allows the vertebra to slide anteriorly due to the force of gravity.

There is congenital spondylolisthesis, in which the patient has the problem from birth, as well as degenerative spondylolisthesis, which comes with the wear and tear of time.

In its extreme and neglected forms, spondylolisthesis can cause severe neurological symptoms, which go as far as partial paralysis and loss of control of urinary and defecation.

The first symptom is back pain (low back pain). In young people it can cause muscle spasm especially in the adductors, resulting in teenagers with this problem walking with tight adductors, bent knees and bending forward.

Once the nerves start to be pressed, then the symptoms are pain, tingling and weakness in the legs.

The diagnosis of spondylolisthesis is made by simple X-ray and perhaps even a CT scan, as the latter better depicts the fracture in the critical area of the vertebra in people whose condition cannot be seen very well on the X-ray.

If there is pain in the legs, an MRI is required to see which nerves are being pressed and to what extent.

In milder forms, conservative treatment is followed, during which the patient is administered anti-inflammatory and analgesic drugs, while physiotherapy is also recommended. The latter is very important because especially in young people, the muscular system can compensate for the bone problem to a certain extent. If patients manage to acquire a good muscular system around the problem, then they achieve a natural “splint” around the vertebrae, which helps significantly with the problem.

If this treatment fails or the problem is of a high degree, then the only solution is surgical treatment.

Spondylolisthesis is an anatomical problem and requires an anatomical solution. Simply put, the normal shape of the spine should be restored, its abnormal mobility should be stopped, and the nerves pressed by the sliding of the vertebrae should be completely decompressed.

This is achieved exclusively by  spinal fusion surgery.

There is the classic open method  of spinal fusion, in which we cut the muscles and expose the bone from the back. Then we pass the intervertebral screws, rearrange the spondylolisthesis, decompress the nerves and stabilize the system in the right position.

The modern trend is to also remove the disc completely and insert  a graft and a support cage in its place.

All of this can be done, but also through holes with the help of X-ray examination and special tools and implants, which ensure a minimally invasive approach.

The next step in the evolution of spinal fusion is the use of robotic technology to place these implants in the safest possible way and with the smallest possible incisions. Robotic surgery ensures small surgical trauma with the highest possible precision.