PATHOLOGY Degenerative changes in the lumbar spine disc degeneration vertebral compression deformities ligamentous laxity deterioration of facet joint cartilage May cause instability and subluxation of on vertebra on another (degenerative spondylolisthesis)
PATHOLOGY. Degenerative changes in the lumbar spine disc degeneration vertebral compression deformities ligamentous laxity deterioration of facet joint cartilage May cause instability and subluxation of one vertebra on another (degenerative spondylolisthesis ). - PowerPoint PPT Presentation
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PATHOLOGYDegenerative changes in the lumbar spine
disc degenerationvertebral compression deformitiesligamentous laxitydeterioration of facet joint cartilage
May cause instability and subluxation of one vertebra on another (degenerative spondylolisthesis)
Anterolisthesis at L4-L5
PATHOLOGY
Backward slippage (retrolisthesis) is generally believed to be asymptomatic and of little clinical significance.
Forward slippage (anterolisthesis) may result in narrowing of vertebral canal and neural foramina (spinal stenosis) leading to development of chronic back pain (with or without leg pain). Compression of L5 spinal nerve may be involved.
PATHOLOGYWhen LS joint is particularly stable, L4 and L5 are more vulnerable to stress forces. If degenerative changes have occurred, anterolisthesis at L4 is more likely.Clinical symptoms associated with anterior subluxation
at L4-L5 80% at L3-L4 10-20%
PATHOLOGY
Spinal stenosis symptoms:
back pain progressing to leg painfunctional independence deterioratesreduced ability to walkreduced ability to carry out ADLs
Symptoms often episodic, no natural resolution over time
EPIDEMIOLOGYSeveral clinical and cadaveric studies suggest that anterolisthesis is 5 times more common in women vs men
2-4 times more common in blacks than whites
4 times more prevalent in diabetics
3 times more common in oophorectomized women compared to controls
Prevalence of lumbar listhesis (L3-S1) in elderly white women (SOF)
05
1015202530354045
65-69 70-74 75-79 80+
Age in years
% p
reva
lenc
e
anterolisthesisretrolisthesis
p for trend = 0.027
p for trend = 0.75
listhesis defined as subluxation > 3mm
CLINICAL RELATIONSHIPSRelationship between radiographic abnormalities and spinal symptoms is unclear.
People with no back pain show disc abnormalities (64%), stenosis (7%) andanterolisthesis (7%) (Boden, JBJS 1990, Jensen NEJM 1994 ).
Not known whether people with sub-clinical disease later develop symptoms.