A distinction is made between stable and unstable spondylolisthesis (if the movement of the torso increases).
Depending on etiology, the following types of spondylolisthesis are distinguished:
dysplastic – an anomaly of the upper sacrum development – is characterized by dysplasia of the upper joint spondylolisthesis;
spondylolysis – a defect in the interarticular part of the arch;
traumatic – fracture of the joint branches or the interarticular part of the arc;
pathological – in case of Pedet’s disease, arthrogripose.
The most frequent level of lesion is Lv, less often Liv. The disc is involved in the pathological process, dystrophic processes are increasing in the body of Lv. osteophytes and cystic cavities appear, the dural canal is deformed.
1) congenital anomaly of the lumbosacral spine;
2) disturbance of metabolic hormonal processes:
3) increased lumbar lordosis (static and dynamic features);
5) trauma (overkinking);
6) hereditary predisposition.
1) Lumbar and lower extremities pain; in children with dysplastic spondylolisthesis, leg pain is more frequent; dull pain at rest, increased with load, bending, lifting of weight; it is hard to get up in the morning, physical exercises are needed; leg pain (more often in the lower legs) is more frequent in adolescents with significant displacement and prolonged stay on the legs;
2) the presence of a ledge (recess) over the austral spine of the displaced vertebrae;
3) deep lumbar lordosis;
4) increased pectoral kyphosis;
5) pelvic inclination forward in the initial stage of the disease;
6) in neglected cases, with the tension of muscles straightening the spine, the “vertical pelvis” – a symptom of the “proud pubis” develops:
7) sign of “shortened torso” – a sign of “telescope”, it corresponds to a significant mixing, and a sign of transverse fold of the abdomen;
8) the sign of the “Schumacher line”; the top of the large spit is connected to the upper anterior iliac and mentally extends this line forward; at the initial stage of the disease the navel will be either on this line or slightly below it; at severe degrees of spondylolisthesis the navel is 10-12 cm below this line;
9) the sign of a “leader”;
10) shortening of the Michaelis rhombus vertical (acuity Lv + upper posterior iliacal acuity + transition of the sacrum to the coccyx):
11) sign of “flat back”, determined when the torso is tilted forward;
12) gluteal muscle atrophy – “heart-shaped muscles”;
1 3) contracture of tibia benders;
14) sign of half-bent knee joints or “sign of an old horse”.
15) rope-walker’s walking – the patient puts his feet inwards;
16) pronounced pulsation of the abdominal part of the aorta;
17) the sign of the “inner threshold” in finger examination of the vagina or rectum:
18) pain at palpation through the abdomen and at palpation of the aorta in the back area.