Spondylolisthesis – Spondylolysis – Spinal fusion – Spinal stenosis
In addition to disc herniation, lower back pain can be caused by abnormal movements of the vertebrae, that is, when one vertebra “slips” on top of the other, or a part of a vertebra is missing, resulting in instability of the structure called the spine. There may be hypertrophy of the ligaments around the vertebrae, or even the formation of new bone (osteophytes), in an attempt by the body to cope with this instability. The mechanisms by which these diseases develop are not yet fully understood; local chronic inflammation also seems to play an important role.
In the case of spinal stenosis, which can be either congenital or acquired, the most common symptom is the so-called neurogenic intermittent claudication (NIC), where the patient can not walk a given distance without developing severe pain in the extremities that forces them to stop for a few minutes.
Treatment – Surgical treatment
There are many ways, surgical or non-surgical, to effectively treat these causes and respective symptoms. For stenosis, surgical treatment is the most appropriate. Removing part of the bone and the ligaments that press on the nerves induce decompression.
In cases of instability, i.e. in spondylolisthesis or spondylolysis, the surgical treatment is spinal fusion. It is an operation that can be performed along the entire length of the spine; it consists in restoring the instability by placing special screws and titanium rods inside the bones. It is often combined with decompression. If carried out at the right indications and in the right extent, it adequately restores the stability of the spine, and the pain is significantly reduced.
Modern techniques and materials have rendered spinal fusion operations very safe, as some patients have gained a bad reputation due to failures in the past. The vast majority of these failures were due to the misuse of the method, the wrong choice of patients, and inadequately trained surgeons. Nowadays, percutaneous spinal fusion is an excellent means of restoring spinal stability and mobilizing patients that rediscover how different their lives can be free of pain.
Last but not least, even in cases where the cause of chronic pain cannot be determined by imaging, there are other techniques, included in Neurosurgical Pain Management, that can provide a solution to the problem.