9/16/2015

AnterolisthesisSymptoms,CausesandTreatment

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AnterolisthesisSymptoms,CausesandTreatment
anirudh
TableofContents:
WhatisAnterolisthesis?
WhatisVertebra?
CausesofAnterolisthesis
HowcanyouavoidAnterolisthesis?
SymptomsofAnterolisthesis
WhatshouldyoudoifyoususpectthatyouhaveAnterolisthesis?
HowisAnterolisthesistreated?
Howistheinterbodyfusionsurgerycarriedout?

WhatisAnterolisthesis?
Thetermanterolisthesisisderivedfromante,aLatinwordthatmeansfrontandlisthesis,a
Greekwordthatmeansslidingdownonapaththatisslippery.Puttingthetermstogether,youwill
haveantelisthesisthatmeansafrontslidedownapaththatisslippery.Thisisthereasonwhy
anterolisthesisreferstotheconditionofthespineinwhichtheupperbodyofvertebral,theareashapedlikedrumatthefrontofeachvertebraeslips
forwardsontothevertebra.
Themagnitudeofslippageisgradedbydoctorsintoscalesfromoneto1to4.IngradeI1anterolisthesis,thereismildslippagethatislessthan25%.In
grade2anterolisthesis,theslippageismorethan25%butlessthan50%.IngradeIII,theslippageismorethan50%butlessthat75%.IngradeIV,the
slippageismorethan75%itmayevenbe100%insomecasesandthesymptomsareusuallyverysevereinthisgrade.
Togetexactlywhatthistermmeansitisalsoverygoodtounderstandthemeaningofthetermvertebra.

WhatisVertebra?
Thevertebra(singular)orvertebrae(plural)arethosebonesthatformanopeninginwhichthehumanspinalcordpassesthrough.Thevertebraeare
positionedontopofoneanotherlikestacks.Atthefrontpartofeachvertebraisathickpartofbonethatisshapedlikeadrumandwhichisreferredtoas
vertebralbody.
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Betweeneverytwovertebraetherearediskswhicharereferredtoastheintervertebraldiscs.Thediscslooklikecushionsandtheyareflatinshape.The
mainpurposeoftheintervertebraldiscsisthattheyabsorbandprotectthespinalcordandthevertebraefromshock.
Inanterolisthesis,thereisabnormalpositioningoftheuppervertebralbodywhencomparedtothebodyofthelowervertebra.Asstatedabove,theupper
vertebralbodytendstoslipinforwarddirectiontothevertebrabelowit.

CausesofAnterolisthesis
Anterolisthesisismainlycausedbygreatimpactonthespinalcord(anterolisthesiscervicalspineorspondylosis)orthevertebramainlythec4andc5(
anterolisthesisc4c5).Itcouldbeduetofallsfromhighheights,bulletwounds,impactfromvehiclecollisions,injuryfromsportingactivities,andsuch
relatedevents.Inseverecases,theanterolisthesisisaccompaniedbythefractureofotherbonesthatareadjacenttothespinalcord.
Intheabsenceoffracturefromsuddenhighimpact,theconditionmayalsobecausedbycoreweakness,instabilityand/orpoorposture.Alltheseevents
willgraduallyleadtodegenerativeanterolisthesischangesormechanicalbreakdownofthesegment.

HowcanyouavoidAnterolisthesis?
Toavoidthiscondition,thepersonsatriskespeciallytheoldermembersofthesocietyareadvisedtoengageinexercisesforanterolistheisandtomaintain
goodbodyposturewhensleeping,sittingandinotherdailyactivities.

SymptomsofAnterolisthesis
Thesymptomsasofanterolisthesismayvarygreatlybecausetheintensityandseverityofthesameisdependentontheamountpinchthattheslippage
exertsonthenerveroots.Thesymptomsmayalsovarydependingontheareathatisaffectedbytheslippage.
TheanterolisthesiscausesSEVEREPAINatthepointofvertebraeslippage.Thatpainmaybelocalizedorwidespread.Thepainwillkeeponworsening
becauseofthemuscularspasmsorguardingasthebodyattemptstoprotectitself.
Themusclespasmsandguardingwillcausethemtotightenandthiswillcauseinflammationandseverepainsaroundthetissuesthatareadjacenttothe
disc,spineandnerveroots.Thepainreceptorswillthusgeneratemoreandseverepainthuscreatingendlessviciouscycleofincreasingpain.
Thepainmaybeexperiencedatoneorbothlegsofthepatient.Somepatientsalsocomplainofweaknessofthelegsandthismayormaynotbe
accompaniedbynumbness.Inanterolisthesis,weaknessofthemusclesindicatesthattheconditionmaycauseseriousdamageofthebodynervesandit
shouldbeaddressedassoonaspossible.
Otheranterolisthesissymptomsinclude:
Tingling
Inabilitytocontrolthelegs
Abnormalsensations
Inabilitytocontrolthepassageofurineorbowelmovements
Ifyouhadaninjury,fall,oryouwereinvolvedinanaccidentandyoustartexperiencingthealreadymentionedsymptomsthenthereishighpossibility
thatyoumightbesufferingfromanterolisthesis.

WhatshouldyoudoifyoususpectthatyouhaveAnterolisthesis?
Anterolisthesisisseriousconditionthatmayhavedebilitatingconsequencesifpropermedicalinterventionisnotsoughtassoonaspossible.Ifyouthink
thatyoumayhavedevelopedanterolisthesisyoushouldactquickly.
Youcansuspecttobehavingthisconditionifyouexperiencelumbarspineinstabilityorseverepainofthespinethatdoesnotsubsideafterthreedays.
Youshouldimmediatelyconsultaneurologistororthopedic.
Themedicalspecialistwillofferyouthefollowingtreatmentsdependingonthegradeofanterolisthesisthatyoumaybesufferingfrom.

HowisAnterolisthesistreated?
Therearevariousanterolistheistreatmentsbuttheyvarydependingontheintensityandseverityofthecondition.Thedoctorwillinmostcasesneedthe
Xrayimagetodeterminethedegreeofanterolisthesis.IftheXraydoesnotgivetherequireddetailthedoctormayneedaMagneticResonanceImaging
(MRI)oraComputerTomography(CT)scan.
Itisimportanttonotethatthepatientmaynotbeabletoregainthephysiqueandfitnessthatwastherebeforetheeventthatcausedanterolisthesis.
ThefollowingaretheavailableAnterolisthesistreatments:
Conservativetreatments:
Thisreferstothenoninvasivemedicalprocedures.Mostdoctorswillwanttotrytheconservativemeasuresiftheanterolisthesisdoesnotpresentvery
severesymptoms.Itsmainadvantageisthatitislesscostlyanditactuallyofferscompleterecoveryifitisprofessionallyofferedbyqualifiedmedical
professionallikephysiotherapist.
ThecommonconservativetreatmentsforAnterolisthesisinclude:
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Rest:
Theanterolisthesispatientisputtobedrest.Notethatthisisnotstrictbedrestbecausethereisneed
forsomemildexercisesofthespineandspinalcord.Thepatientsareadvisedtoavoidengagingin
activitiesoreventsthatmaycausefurtherslippageorstrainingofthevertebrae.
Allpatientssufferingfromanterolisthesisareadvisedtotakeseveraldaysofffromworkandthen
spendthefollowingfewdaysorweeksonbedrestthatisinmostcasescoupledwithmildexercises
foranterolistheis.
Thepatientmayundertakethistreatmentathomeoratthehospitaldependingontheseverityofthe
condition.Ifthepatientisunabletocontroltheurineandbowelmovementsasaresultofthe
condition,heorsheshouldseekadviceonthedietstotakeandthosetoavoid.
PhysicalTherapies
Thisisinmostcasesaccompaniedbybedrest.Thepatientisputonphysicaltherapiesbywelltrained
physiotherapists.Itwillinmostcasesinvolveexercisesforanterolisthesissoastoimprovethemovementofthediscsandrelievethepain.The
physiotherapistswillfirstassessthemuscoskeletaldysfunctionsbeforedecidingonthebesttherapy.
Thedurationoftherapymaytakeseveralweeksormonthsdependingontheintensityandseverityofanterolisthesis.Itmayinvolveposturaltraining,heat
massage,electronicsimulationandvariousothernoninvasiveproceduresthatareaimedatrelivingthepain.Backstretchersmayalsobeusedinthe
therapy.
Thepatientmayalsobegivenantiinflammatorymedicationseitherorallyorthroughinjectiontopreventtheinflammation.Painkillersarealsogiven
orallyorthroughinjectionssoastoalleviatetheseverepainthatcharacterizesanterolisthesis.
NotethattheseconservativetreatmentsareonlylikelytoworkingradeIanterolisthesisandinsomegradeIIanterolisthesiscases.Ifthesetreatmentsdo
notworkortheydonotproducetheworthwhileorexpectedresults,thepatienthasnooptionbuttoundertakesurgery.
Likealltheothersurgeries,thisisaninvasiveprocedurethathasvariousrisks.Inmostcaseshowever,thesurgeryissuccessfulandthepatientwillget
relief.Thesurgeryfortreatmentofanterolisthesisisreferredtoasinterbodyfusion.

Howistheinterbodyfusionsurgerycarriedout?
Ininterbodyfusion,thesurgeonwillmakeanincisioninthepatientsback.Theincisionwillbedonethroughthemidlayersofthoseligamentsand
muscleswhicharepositionedonbothsidesofthespine.Notethattheligamentisthetoughtissuesthatliebetweenthejoints.Itattachesthejoints,holds
themandseparatesthemfromeachother.Thejointisthatplaceinwhichtwobonesconnecttoeachother.Itallowsforbonemovementthuscausing
generalbodymovementslikebendingandtwisting.
Afterthesurgeonhascutsthealreadymentionedareas,theattachmentstothelaminaeandthespinuosprocesseswillbefreed.Thelaminaerefertothe
flatandthinpartsofthehumanvertebralarch.Thevertebralarchreferstoringsofbonesthatsurroundthehumanspinalcord.Theseringsofbones
surroundthespinalcordwithothervertebralbodies.Thespinuosprocessesrefertothebonypartswhichprojectfromthevertebraesback.
Thesurgeonsusespecialinstrumenttoremovethesmallpiecesofbonesfromthelaminasuchthatthenervesarenowvisible.Thenerveswillthenmoved
veryslightlysothatthe
Intervertebraldiscsareclearlyexposed.Byuseofspecialmedicalinstruments,thesurgeonwillremovethediscthroughtheleftorrightsideofthe
patientsspinalcanal.Notethatthespinalcanalreferstothespacethatisbetweenbonystructure(whichsurroundsthespinalcord)andthespinalcord.
Oncethesurgeonhasremovedthedisc,heorshemustalignthepatientsvertebra.Theemptyspacethatremainsafterthedischasbeenremovedwillbe
filledwithabone.Thisboneisinmostcasestakenfromanyotherpartofthebodyofthepatient.Thesurgeonmayalsouseaboneclock(anartificial
bone)tofillthespacethatusedtobeoccupiedbythediscthathasbeenremoved.
Afterfillingofthespacethatisinbetweenthevertebrae,thepatientsvertebraearenowfusedtogether.Thefusionshouldbedoneverycarefullyto
ensurethatthebonecanneverslideorslipforwardsagainthuscausinganotherincidenceofanterolisthesis.Toensurethis,thesurgeoncanstabilizethe
fusedvertebraebyfasteningitwithscrewsorotherhardware.
Nowadays,surgeonsconductinganterolisthesissurgeryhaveentrenchedthepracticeofimplantingspinalcageafterremovingthediscthatliesinbetween
thevertebraethathadslippedovertheother.Thespinalcageisbasicallyasmallcagethatisthreadedandfilledwithtinynaturalbonepieces.Thesurgeon
willcapandimplantthispackedcageinbetweenthevertebrae.
Permanentstabilityandfusionwillbeaccomplishedwhenthenaturalbonewillgrowthroughtheholesthatareinthecagesuchthatitfuseswiththetiny
naturalbonepieces.
References:
http://www.spine.org/Documents/spondylolisthesis_Clinical_Guideline.pdf
http://cedarssinai.edu/Patients/HealthConditions/Anterolisthesis.aspx

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