The number of people with lumbar spondylolisthesis in Taiwan Province is over 1 10,000. Can you not have an operation?

About two years ago, a 67-year-old woman surnamed Cai developed symptoms of persistent waist pain. At first, she thought she was old, her lumbar spine was aging or her muscles were stiff, so she put a plaster on the affected area. Unexpectedly, it didn't work. Gradually, as long as she walked for a short distance, her legs would be sore or even numb. Accompanied by her family, she went to see a doctor before she was diagnosed as "degenerative lumbar spondylolisthesis", which is a disease that often occurs in women over 50 years old.

What is lumbar spondylolisthesis? The lower half of the human spine consists of five lumbar vertebrae, five sacrums and coccyx. There are bone plates and small joints between the left and right sides of the upper and lower vertebrae. When these structures rupture due to congenital malformation or injury, the upper and lower vertebrae may separate. If both sides are broken, the vertebrae will slide forward due to gravity, which is medically called "lumbar spondylolisthesis". The most common position is between the fifth lumbar vertebra and the first recommended vertebra, followed by the fourth and fifth lumbar vertebrae.

The causes and types of lumbar spondylolisthesis are not specific to race and age. According to clinical statistics, on average, 5% of the population will have the problem of lumbar spondylolisthesis, which means that more than 654.38+00000 people in Taiwan Province suffer from this disease, but only a few people will have symptoms, and about 654.38+00% of them need surgery because of serious symptoms. Lumbar spondylolisthesis can be divided into congenital, acquired and traumatic.

1. Congenital: Due to the congenital structural abnormality of the lumbar spine, dislocation is easy to occur, usually between the waist and the sacrum.

Second, acquired: clinically, fracture and degenerative lumbar spondylolisthesis are more common.

(1) The real cause of spondylolisthesis caused by vertebral arch fracture or abnormal extension is still inconclusive in medical field, which may be related to heredity or trauma. Pedicle fractures are common in one or both sides, especially in the fifth lumbar vertebra, which is more common in young people with low back pain.

(2) Degenerative lumbar spondylolisthesis: It mostly occurs in women over 50 years old, especially in the 4th to 5th lumbar vertebrae. The reason is pregnancy and joint relaxation, which leads to the narrowing of intervertebral disc space and the bending and deformation of joint ligament.

Traumatic spondylolisthesis: Fracture spondylolisthesis caused by serious injury.

The most common symptom of lumbar spondylolisthesis is back pain, which may be on one side or both sides. When the back is stretched backwards, the pain will be aggravated. Because the lumbar spine is unstable, it will cause nerve root compression or traction. Patients often have sciatica similar to that caused by disc herniation. Pain in the lower back sometimes extends to the buttocks or the back of thighs. Some patients have symptoms of spinal stenosis.

How to diagnose lumbar spondylolisthesis? If there are symptoms of suspected lumbar spondylolisthesis, the doctor will arrange X-ray examination of the front and side of the lumbar spine, which can help to check the position and degree of spondylolisthesis. Lateral photos of flexion and supination of lumbosacral vertebrae can help doctors to further understand the instability of lumbosacral vertebrae. When the patient has symptoms of nerve compression, further computerized tomography, spinal photography or magnetic resonance scanning will help to further confirm the location and severity of nerve root compression.

Not all lumbar spondylolisthesis requires surgery. If lumbar spondylolisthesis occurs and affects daily life, it is necessary to seek medical treatment. There are two treatment methods: conservative treatment and surgical treatment. In fact, not all patients with lumbar spondylolisthesis need surgery, unless the patient's pain lasts for more than 3 to 6 months, the lumbar spondylolisthesis exceeds 50%, or the nerves are obviously compressed, resulting in dyskinesia or posture deformation, which has not been improved after conservative treatment.

Conservative treatment methods include:

(1) Bed rest: mainly to remove gravity to relax the back and accelerate recovery.

(2) Medication: Take non-steroidal anti-inflammatory drugs, painkillers and muscle relaxants according to the doctor's advice.

(3) Use a back frame: support the body and limit the range and angle of motion of the spine.

(4) Rehabilitation treatment: receive hyperthermia and electrotherapy to promote muscle blood circulation and relieve soreness.

What are the surgical treatments? As for surgical treatment, according to the degree of lumbar spondylolisthesis and nerve compression, there are four surgical methods, including laminectomy, posterior fusion combined with spinal internal fixation, posterior interbody fusion and posterior open interbody fusion. More than 85% patients recovered well after operation. However, there will also be cases of lumbar spondylolisthesis again due to the displacement of the surgical cage.

How to prevent lumbar spondylolisthesis? As for the preventive measures to avoid lumbar spondylolisthesis, it mainly lies in the continuous muscle strength training of abdominal muscles, plus back stretching exercise to strengthen the muscles beside the spine. In addition, we should also pay attention to avoid excessive back stretching activities, such as not bending down to pick up things or lifting more than 3 kilograms of heavy objects. When cleaning, you can use a broom with a long handle and wear shoes in a sitting position, which can avoid the symptoms of lumbar spondylolisthesis.