People employed in jobs that require hard manual
labor or athletes can have a
chronic split in an inter-articular part of the spinal curve. For example, wrestlers, gymnasts
or manual laborers sometimes overload their spinal columns to such an extreme
that even bone cannot tolerate it. At that point, a split in the vertebral
curve or near its joint appears. A split is an actual fracture and the main component
of treatment for a fracture is immobility of the fragments. That’s why a broken
arm or leg is placed in a plaster cast. But how can you encase the whole body in
plaster, especially since this split can’t be seen on X-ray pictures? This is
exactly why these people “buck up” under severe back pain and continue to train
or work, telling themselves: “The most important competition of the
season is right around the corner.” Or “A
well-paying client has asked me to carry
a piano to the eighth floor of a building that has no elevator.” What happens then? When severe back pain is
ignored?
Between immovable bone fragments, a callus appears.
This callus turns into a normal bone later on. But in our case, the fragments,
that is, the parts of vertebral curves, continue being loaded and microscopic
movements continue. So at the moment of the next load, the split becomes bigger
and a callus does not form. Instead of a callus, a scar forms and the fracture
itself is called fatigue. Of course, this
scar can’t hold a vertebra in place, so the vertebra shifts. At first, it only
shifts one millimeter, but
later, as the load becomes bigger, the vertebra shifts more and more, right up
to the moment when two neighboring vertebrae can lose their connection with
each other.
Sometimes, at the initial stage of the disease, a “shifting” vertebra
can be returned to its normal position if a certain pose, usually bending
backwards, is struck. That’s why, when people with this condition walk, they
avoid bending forward. They throw back their head and chest. This unstable vertebra
can prevent a correct and timely diagnosis. A patient complains of back and leg
pain, but there are no shifts visible on an X-ray or MR-images which are taken
with the patient lying on their back, which is how these images are obtained in
most cases. In this horizontal position,
the vertebra just “fell” back into place and the spondylolisthesis disappeared.
To diagnose these shifts, it’s necessary to examine the spine under load. To do this,
functional testing should be completed: X-rays are taken in positions of
maximal bending and unbending. In addition, special MR equipment exists that is
able to take images of the body in a lying position and in a standing position under
vertical load. This MRI equipment might not be available to everyone, but an
X-ray can be completed in any hospital.
If
a person suffers from spondylolisthesis, they feel pain not only in their back.
The shifted vertebra stretches the vertebral ligaments and joints and, as you know,
nerve roots and the spinal cord are inside the spinal column. While they are
slightly shifting, the vertebrae will trap these nervous structures like tongs.
That’s why pain will occur in one or both legs in addition to pain in the
spine.