Lumbar spondylolysis

The lumbar vertebral arch is fractured, which is particularly harmful. It usually occurs in the lumbar vertebra four or five. Because the bone structure in this area is relatively fragile, if it is affected by external force or violent impact, it may cause this kind of harm. When this happens, it must be treated in time. There are many treatment methods, the most common of which are surgical treatment and non-surgical treatment.

Clinical manifestations

1. Symptoms: Patients with lumbar spondylolysis in the early stage may not have symptoms. Some patients may experience lower back pain, which is usually mild and often worsens after fatigue. The condition usually improves after proper rest or taking painkillers. Low back pain is intermittent at first, but may become continuous later, and in severe cases it may affect normal life. The pain may radiate to the sacrum, buttocks, or back of the thigh at the same time. If combined with lumbar disc herniation, it may manifest as sciatica symptoms.

2. There are usually not many physical signs. No abnormalities may be found in patients with simple isthmus collapse without slip. During physical examination, there is only slight tenderness over the spinous process, between the spinous processes, or beside the spinous processes. Waist movement can be unrestricted or slightly restricted. Other examinations of the sacrum and buttocks usually showed no abnormal objective signs. People with lumbar spondylolisthesis may have a special appearance of lumbar convexity, buttocks convexity, abdominal sagging and shortened waist. At this time, the spinous process of the diseased vertebra protrudes posteriorly, while the spinous process above it moves forward, and the two are not in the same plane. There may be a local feeling of depression and an increased posterior protrusion of the sacrum. There is tenderness between the lumbar and sacral spinous processes, and the back extensor muscles are mostly tense. The movements of the waist are restricted to varying degrees, while the movement, sensory function and tendon reflexes of the lower limbs are usually normal.

treat

1. Non-surgical treatment: Not every patient with spondylolysis or spondylolisthesis requires treatment. A considerable number of patients with spondylolysis and grade I spondylolisthesis have no symptoms and do not require treatment. In most cases, nonsurgical treatment is effective and includes nonsteroidal anti-inflammatory analgesics, short-term bed rest, avoidance of heavy lifting and strenuous activity, bracing, and back and abdominal muscle exercises. After 6 to 8 weeks of treatment, symptoms can be improved, which is especially suitable for adolescents who have not yet matured. 2. Surgical treatment is suitable for persistent low back pain symptoms or recurrent episodes that are not responsive to non-surgical treatment. Both young and middle-aged patients can undergo surgical treatment. For those with intervertebral disc herniation, the herniated nucleus pulposus can be removed at the same time. Surgical treatment of isthmic rupture: Local bone grafting for isthmic nonunion: For patients with lumbar isthmic nonunion, local bone grafting is performed at the isthmic nonunion. That is, after removing the fibrous callus at the isthmic nonunion, the transverse process of the affected vertebra is grafted across the isthmic fissure to the vertebral lamina without fusing the joint. It can also be fixed by combining screw fixation with internal fixation.

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