Lumbar slippage (Lumbar spondylolisthesis), obesity, misuse of the waist, concussion (hit, fall, blow to the spine in the lumbar region), tumor, degeneration (deterioration of the ligament structures connecting the vertebrae due to aging), genetics, although not proven yet. It is a disease due to the weakness of the connective tissue, as a result of which the vertebrae slide over each other and press on the nerve roots.
It may manifest itself with pain and numbness in the waist, hips and legs. The most typical story is that patients’ road walking distances are shortened. When they walk for a short time, they need to sit because of pain and/or numbness in their legs. If they force themselves to walk a little longer, their legs will get stuck together and they will experience falls and sprains. Fixed standing times are very short.
Patients whose history is taken and neurological examination is performed are evaluated with tests such as moving x-rays, MR, CT, EMG… The treatment plan is started according to the condition and degree of the disease.
The most satisfactory treatment known in patients who do not respond despite all evidence-based medical practices is surgery.
The main purpose of the surgery is to remove the pressure on the nerves, if necessary, to provide stability to stop the slipping and to prevent the slippage from advancing and pressing on the nerves again by providing fusion (fusion, freezing) between these sliding bones in a long time.
What can happen if the attempt is not made? In the absence of intervention, low back and leg pain and increased numbness with walking may continue, as well as an increase in existing neurological disorders and new deteriorations and damages may be added. Even if surgery is performed in the future, these deteriorations may be permanent due to the structural features of the nervous tissue. Rarely, there may be permanent or temporary disruptions in urination, defecation and sexual functions of varying degrees.
What kind of treatment/intervention will be performed: The patients receive general anesthesia and are operated in a supine position. A skin incision is made to reveal the relevant levels, and the waist muscle is duly separated from the bone structure on both sides. The level is confirmed by X-ray, and then the bone structures forming the posterior wall of the spine at the relevant level are removed sufficiently and the structures that press on the nerve roots (thickened articular surface, ligaments, impaired discs) are cleaned. All the nerves under pressure are relieved. The main purpose is to free the nerves from compression and to prevent them from being exposed to pressure again. Special screw system is placed in the bones at a sufficient level in cases where mobile slip is detected in previous examinations. The bone fragments that form the posterior wall of the originally removed spine at the relevant level, and the bone fragments taken from the hip bone when necessary (all of which are made up of the patient’s own bone and are the material that provides the most ideal bones to fuse) are spread around the rods and screws. The aim is to integrate these bones with the surrounding bones over time and to prevent the mobility in this region and to ensure that there is no pressure on the patient’s nerves again. The screw system provides this immobility until the interbony fusion occurs, that is, the screw system acts as a kind of concrete mold.
In some cases, if the slipping has stopped and there has been spontaneous fusion between the bones, microsurgery can be performed from one side, and the thickened joint tissues can be cleaned, sufficient canal expansion, relaxation of the nerves and relief from pressure can be achieved. In this way, these surgeries are terminated without the use of screws, and the ground is not prepared for the problems that people who are already over middle age with weak bone structure may experience due to screw slippage, movement and stretching in the future.
Side effects that may occur:
Pain and discomfort at the surgery site are temporary.
Complaints do not go away, the wound may not heal normally, it may thicken and become red (keloid), and the scar may be painful. Since these patients have been under nerve pressure for a long time, immediate recovery from evening to morning is not expected. Pain due to severe compression passes in the early period, but chronic pain passes after the complete regeneration process of the damaged nerves. Although this period varies according to the patient and the disease, it may take 3-12 months.
Inflammation, bleeding at the surgical site. The screw may injure the nerve root, resulting in pain and weakness. Meningitis and delayed wound healing may develop due to cerebrospinal fluid discharge, and antibiotic treatment and additional surgical treatment may be required. Injury to nerve roots, recurrence of hernia at the same level or adjacent levels (may cause pain and may require additional surgery), injury to the nerves going to the large intestine and urinary bladder, and injury to the main vessel may occur.
Small air spaces in the lung may be closed, and there may be a risk of post-operative fever and lung inflammation. Treatment may require antibiotics and physical therapy. Clots can form in the legs, causing pain and swelling. Rarely, a piece of this clot may break off and reach the lungs and be fatal. Heart attack and cerebral palsy (stroke) may occur due to loading on the heart.
