It'll be replaced by a small "cage" containing a bone graft to hold the bones in your spine apart.
The operation is performed under general anaesthetic , which means you will not be awake. Surgery often relieves many of the symptoms of spondylolisthesis, particularly pain and numbness in the legs.
Retrolisthesis and Spine Surgery
But it's a major operation that involves up to a week in hospital and a recovery period lasting months, where you have to limit your activities. Read more about lumbar decompression surgery , a type of spinal surgery used to treat compressed nerves in the lower lumbar spine. Page last reviewed: 2 April Next review due: 2 April What causes spondylolisthesis? In most cases, non-surgical treatments will be recommended first. It is also more common in females than males by a margin. Degenerative spondylolisthesis is relatively rare at other levels of the spine, but may occur at two levels or even three levels simultaneously.
While not as common as lumbar spondylolisthesis, cervical spondylolisthesis in the neck can occur. When degenerative spondylolisthesis does occur in the neck, it is usually a secondary issue to arthritis in the facet joints. This article reviews the underlying causes, diagnosis, symptoms, and full range of surgical and non-surgical treatment options for degenerative spondylolisthesis.
Every level of the spine is composed of a disc in the front and paired facet joints in the back. The disc acts as a shock absorber in between the vertebrae, whereas the paired facet joints restrain motion.
They allow the spine to bend forwards flexion and backwards extension but do not allow for a lot of rotation. As the facet joints age, they can become incompetent and allow too much flexion, allowing one vertebral body to slip forward on the other.
Click for larger image. Unfortunately, preoperative myelopathic symptoms presented again after 3 months, it were aggravated especially in the extended neck position and lying down.
Vertebral Slippage | The Spinal Foundation
On the visitation at our hospital, the patient presented grade 4 weakness of the overall limbs and only walkable with a cane. Myelopathic signs were demonstrated with a positive Hoffman sign and an increased deep tendon reflex bilaterally. Based on the aggravation of symptoms with neck extension, dynamic MRI was applied to determine if there is cord compression depending on the cervical postures. However, there was no definite compressive effect of the posterior paraspinal muscles.
Retrolisthesis Differs From Spondylolisthesis
Cord compression is partly suspected on flexed neck posture, even though there is no definite obliteration of ventral cerebrospinal fluid space. Unlike neutral neck position, cord compression was confirmed by dynamic MRI Figure 3. There was no definite compressive effect of the posterior paraspinal muscles. C, F On the flexed neutral neck postures, cord compression is partially suspected on the axial view. There is slight amount of pressure on the cord without obliteration of ventral CSF space compared to extended neck posture.
Additional decompressive laminectomy on the C6—7 levels was done, and then posterior screw fixation was conducted from C2 to T1 by placing a dome-shaped crosslink to prevent cord compression by the post-laminectomy membrane Figure 4.
Vertebral Slippage (Spondylolisthesis & Retrolisthesis)
A few days after the operation, the patient showed the improvement of symptoms. After 18 months of follow-up, the patient was able to walk normally without any assistance, and there was only a slight numbness on the bilateral hands.
FIGURE 4 A—C Additional decompressive laminectomy was performed on the C6 and C7 levels with excoriation of adherent tissue around the previous laminectomy site, and then posterior screw fixation was done from C2 to T1 by placing a dome-shaped crosslink to prevent cord compression by the posterior stuructures. D After 18 months of follow-up, there was no cord compression either anteriorly and posteriorly on magnetic resonance imaging. Generally, posterior surgery such as laminoplasty may be recommended in multi-segment cervical OPLL with a relatively preserved lordotic curve.
One reason leading to further surgery after posterior decompression is re-pressuring at the main existing lesion by progression of cervical kyphosis. The other reason is the growing of OPLL.
With the above hypotheses, we think postoperative changes in cervical alignment on the overall cervical curve and single segment might reflect dynamic instability, which can develop more frequently on the segment with an incomplete formed bone bridge of OPLL. It can occur in the most vulnerable area, such as an incomplete bone bridge with the increased dynamic load in the environment where the movement of the upper and lower structures is lost.
In this study, our patient showed increased range of motion and development of retrolisthesis on C4—5 segment with non-fused OPLL mass following posterior decompression. The upper and lower fused segments around the C4—5 lost its normal movement by fused continuous OPLL segments and anterior fusion surgery, respectively. As a result, overload occurred in C4—5 segment to compensate for the loss of movement in the other segments. On the contrary to the existing theory, progression of cervical kyphosis; unstable changes with retrolisthesis on the vulnerable segment were the main reason for cord compression.
Recently, dynamic MRI has been used to detect cervical cord compression by the paraspinal muscles after laminectomy or the change of cervical canal depend on neck position. However, dynamic MRI identified cervical cord compression with the anterior structure developed by instability and retrolisthesis as the cause of symptoms, with were not of posterior origin.
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When considering surgical treatment in the posterior approach in multi-segment cervical OPLL, the degree of bone bridge formation at each OPLL segment should be considered with the cervical curve. Posterior fusion and screw fixation are also considered if there is a non-fused OPLL segment that tends to become unstable despite a lordotic cervical curve.
Additionally, when renewed neurological deterioration has developed under a preserved cervical lordotic curve and successful decompression was shown on static MRI following laminoplasty or laminectomy, it can be helpful to investigate cord compression by instability of non-fused OPLL segment using dynamic MRI.