Definition
From the Greek spondilo (vertebra) and olisthesis (sliding), the spondylolisthesis outlines a painful pathological condition in which a vertebral portion (or the entire vertebra) slides on another, posteriorly, laterally or anteriorly. In most of the patients diagnosed, an anterior sliding (anteriolisthesis) is observed, affecting the 4th and 5th lumbar vertebrae.
Causes
Spondylolisthesis is often an expression of a congenital malformation or an acute and sudden trauma. In adults, spondylolisthesis is often favored by rheumatoid arthritis or other degenerative diseases: in similar situations, sliding between the fourth and fifth lumbar vertebra is often observed.
- Risk factors: traumatic fractures (from weight lifting), stress fractures, bone pathologies
Symptoms
The symptomatic picture of spondylolisthesis varies a lot: some patients do not complain of any symptoms, while for others the disorder is very painful. Among the most recurrent symptoms, we find: pain in the thighs and buttocks, lower back pain, muscle stiffness and tension in the affected area. The weakness of the lower limbs and the hypersensitivity that accompanies the disorder often derive from the pressure exerted on the nerves, responsible also for pain that gradually radiates in all the legs.
Information on Spondylolisthesis - Drugs for the Treatment of Spondylolisthesis is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Spondylolisthesis - Drugs for the treatment of Spondylolisthesis.
drugs
The treatment aimed at treating spondylolisthesis is subject to the severity of the underlying pathological condition; many patients benefit simply by practicing specific stretching exercises and re-education techniques associated with small lifestyle changes (eg correct posture). In the case of spondylolisthesis, symptomatic or not, it is recommended to avoid the practice of extreme sports exercises or which could aggravate the pain and lumbar arching (lumbar hyperlordosis). It is particularly useful to strengthen the abdominal muscles and the stabilizing muscles of the pelvis, as well as to follow a stretching course on the spinal muscles.
In the event that physical exercises do not bring any benefit, it is possible to proceed with secondary interventions, leaving surgery as a last resort: in the symptomatic forms of spondylolisthesis, the administration of NSAIDs, therefore non-steroidal anti-inflammatory drugs, is particularly effective for control of pain. Some patients benefit from wearing the rigid orthopedic bust.
The surgery, as mentioned, is reserved exclusively for extreme cases, in which the spondylolisthesis creates acute pain and heavily affects the quality of life of the patient who is affected: the intervention aims to align the vertebra - slipped forward - with the one below.
- Eptotermin alfa (eg Opgenra, Osigraft): it is a drug widely used in therapy for the treatment of severe forms of spondylolisthesis, especially inoperable ones. The active ingredient is also used following a targeted surgical intervention (autologous grafting operation), which has not reported any beneficial effect to the patient. The active ingredient is an analogue of bone morphogenic protein 7 (BMP-7), a very important protein involved in the complex mechanism of bone reformation: this drug is therefore indicated to promote fusion between two vertebrae in patients with spondylolisthesis, previously operated without success. The use of the drug is exclusively medical; the active ingredient is formulated as a powder, to be joined later to the carmellose drug, to prepare a pasty suspension to be implanted (the drug must be applied on the sides of the involved vertebrae, to stimulate the growth of new bone tissue that will be used for the fusion thereof).
Non-steroidal anti-inflammatory drugs for pain control: the administration of these drugs is NOT useful for healing spondylolisthesis, but to temporarily cover the pain.
- Ibuprofen (eg. Brufen, Moment, Subitene): for medium-moderate pain, it is recommended to take an active dose of 200-400 mg (tablets, effervescent sachets) by mouth every 4-6 hours after meals, at need. Do not take more than 2.4 grams per day.
- Naproxen (eg Aleve, Naprosyn, Prexan, Naprius): it is recommended to take the drug at an oral dose of 550 mg once a day, followed by 550 mg of active every 12 hours; alternatively, take 275 mg of naproxen every 6-8 hours, as needed. Do not exceed 1, 100 mg per day.
- Acetylsalicylic acid (eg. Aspirin, Vivin, Ac Acet, Carin): the drug, indicated for adults only, should be taken at a dose of 325-650 mg orally or rectally, every 4 hours, as needed. Do not exceed 4 grams per day. In the case of osteoarthritis associated with spondylolisthesis, it is possible to take 3 grams per day of medication, possibly fractionating the load in several doses. The administration of the drug to children under the age of 12 can cause serious side effects, such as Reye's syndrome, liver dysfunction and brain changes.
- Codeine (eg. Codein, Hederix Plan): this is a narcotic drug used when the previously described NSAIDs do not exert their therapeutic effect, due to too intense pain. As an indication, take a dose of 30 mg, orally, intramuscularly or intravenously, every 6 hours, as needed. In some patients, it is necessary to increase the dose to 60 mg every 4 hours. Don't abuse. Follow the instructions prescribed by your doctor.
Steroid drugs for pain : thanks to their powerful anti-inflammatory effect, corticosteroids are also used to control the pain and inflammation that accompanies spondylolisthesis. They can be taken orally or injected directly on site.
- Prednisone (eg. Deltacortene, Lodotra): take 5 to 60 mg of active in 1-4 divided doses during 24 hours. Consult your doctor. Do not prolong the therapy beyond what is due.
- Methylprednisolone (eg Advantan, Solu-medrol, Depo-Medrol, Medrol, Urbason): to ensure a discreet anti-inflammatory effect, take for os 4-48 mg per day of medication. Consult your doctor.
It should be pointed out that the use of steroid drugs, even in the context of spondylolisthesis, must always be established by the doctor and must never be abruptly interrupted on his own initiative.
