Retrolisthesis: Definition and management (what to do?)

Le retrolisthesis is an infrequent anomaly affecting the spine. It is characterized by the slip of a vertebrate rearward relative to the underlying vertebra. It is therefore the opposite of spondylolisthesis where the vertebra slides forward.

Retrolisthesis usually involves neck or lower back. It can also be observed in the thoracic spine, but more rarely.

The management of retrolisthesis depends on its cause, the amount of slippage and the compressed anatomical elements. It usually involves treatments medicated analgesics, physiotherapy or the osteopathy. Surgery, on the other hand, will only be considered as a last resort.

What is retrolisthesis?

The term « retrolisthesis » comes from Latin « retro » which means backwards, and from ancient Greek « listhesis » meaning slip. Retrolisthesis therefore means « slide back ».

In medicine, retrolisthesis designates a condition of the spine characterized by a backward slip of a vertebra compared to the one located just below (from 2mm or more).

In the majority of cases, this sliding takes place at the level of the cervical region ou lumbar (particularly between vertebrae L4-L5 or L5-S1). Involvement of the dorsal segment of the spine is much less frequent.

Depending on the type of vertebral slip, we can distinguish three main varieties of retrolisthesis:

• Partial retrolisthesis: the affected vertebra slides backward relative to the vertebra below or above.

• Stepped retrolisthesis: the affected vertebra slides backward relative to the vertebra located above and forward relative to the vertebra located below. This tilting of the vertebra gives a "staircase" aspect to the imaging.

• Complete retrolisthesis: here the vertebra moves with its whole body backwards. It therefore finds itself shifted in relation to the above and underlying vertebrae.

Just like the spondylolisthesis, retrolisthesis can be classified in 4 grades of severity according to the importance of the sliding of the vertebra (expressed in percentage):

• Grade 1: displacement up to 25%,
• Grade 2: from 25 to 50%,
• Grade 3: from 50 to 75%,
• Grade 4: from 75 to 100%.

What are the symptoms of retrolisthesis?

Symptoms of retrolisthesis vary from person to person depending on slip location and anatomical structures affected (vertebral joints, ligaments, nerves, etc.).

They are (for the most part) the consequence of a compression of nerve elements by displaced vertebraIncluding spinal cord and spinal nerve roots.

In general, the retrolisthesis can be translated clinically by:

• A pain ou gene at the seat of the slide: neck pain, lumbar or back pain. This pain can be spontaneous or caused by digital pressure and certain movements (walking, twisting of the spine, etc.).

• A arch ou bump palpable and/or visible at the level of the spine which corresponds to the displaced vertebra.

• A overall reduction in spine mobility, but in a particular way at the level of the segment concerned.

• A stiffness back.

• Neurological symptoms at the level of the areas innervated by the nervous structure(s) compressed by the displaced vertebra: pain (sensation of electric shock, sciatica, etc.), numbness, tingling, reduction or loss of sensitivity, muscle weakness, motor disorders, etc.

When compression is mild or absent, due to very slight slippage (grade 1), retrolisthesis may remain asymptomatic.

On the contrary, when the spinal cord or its nerve roots are very compressed by a significant retrolisthesis (grade 3 or 4), the symptoms can go as far as paralysis of one or more members.

What are the causes of retrolisthesis?

Different pathologies related to the spine can cause or contribute to the development of retrolisthesis. Here is a list of some of them:

• Degeneration of intervertebral disc (degenerative disc disease),
• Arthritis or osteoarthritis of the posterior vertebral joints (facet osteoarthritis),
• Diseases that weaken the bones (osteoporosis, vitamin-calcium deficiencies, hyperparathyroidism, long-term corticosteroid intake, etc.),
• Spinal trauma (such as cervical sprain or lumbar sprain),
• Weakness of the dorsal and/or abdominal muscles (myopathies, etc.),
• Osteomyelitis (bone infections) affecting the vertebrae (especially tuberculosis or Pott's disease ")
• Deformities of the spine (in particular the exaggeration of the lumbar curvature or " lumbar hyperlordosis ")
• Congenital malformations of the spine.

In addition, certain risk factors can precipitate the development of retrolisthesis. The most frequently encountered are obesity and overweight (excess stress on the Lumbar spine), as well as the bad postures.

How is the diagnosis made?

To put the diagnosis of retrolisthesis, the doctor begins by collecting as much information as possible, through a detailed questionnaire and a complete physical examination.

During the interview, the doctor will tell the patient about his medical/surgical history (personal and family), his profession, his symptoms (type, date and mode of onset, circumstances of occurrence, etc.).

Then, he examines the patient from every angle, with particular emphasis on the whole column vertebral. He will thus be able to objectify pain, see or feel a bump, note a deformation of the spine (hyperlordosis for example)... This part of the physical examination should be able to determine the slip seat vertebral.

THEneurological examination is also essential, because it makes it possible to objectify certain complaints of the patient secondary to the compression of the nervous structures by the displaced vertebra (muscular weakness, disturbances of sensitivity, etc.).

At the end of the clinical examination, the doctor prescribes a standard x-ray of the spine (especially in profile) in order to visualize the retrolisthesis and specify its characteristics (exact site, type, grade, elements pointing towards the cause, etc.).

Other imaging examinations (CT scan, MRI) are sometimes necessary to assess the impact of retrolisthesisIncluding spinal cord compression or its nerve roots.

What is the treatment for retrolisthesis?

The treatment of retrolisthesis depends on several factors, in particular the seat of the slip, its grade, the severity of the symptoms, the impact on daily activities and quality of life... Two main approaches are possible:conservative approach (non-surgical) and thesurgical approach.

Conservative approach

Retrolisthesis is not synonymous with surgery. To arrive at this radical solution, one must first try all the conservative methods who understand :

• Drug treatment: it is most often a combination of analgesics and anti-inflammatories to which may be added, depending on the case, neurotropics, antidepressants, corticosteroids, etc.

• The application of heat on the painful area to relax the muscles (hot water bottle, hot bath).

• Physiotherapy (physiotherapy): rehabilitation sessions at a physiotherapist (physiotherapist) based on exercises to strengthen the muscles of the back and abdomen, stretching...

• From osteopathy: osteopathic manipulation techniques do not allow the vertebra to be “returned” to its initial position, but aim to prevent worsening of slippage and relieve certain pains.

• Immobilization: lumbar corsets or cervical collars can be used to immobilize the affected segment of the spine. It is only a temporary solution that can be used for analgesic purposes.

• Corticosteroid injections: the injections are made directly at the level of the structure irritated by the sliding (the facet joints or near a compressed nerve root for example).

Tools and accessories

In addition to the treatments mentioned above, there are several products and accessories available on the market to relieve lumbar pain related to retrolisthesis. It should be remembered that these tools generally provide temporary relief, and should be used sparingly. Among the products recommended by our professionals, we have:

• Acupressure mat (with pillow)
• Shiatsu neck massager
• Manual neck massager
• massage gun
• Cervical massage cushion
• Cervical relaxation hammock
• Massage roller
• Foam roller (sport massage roller)
• Heated lumbar belt
• Postural T-Shirts
• Ergonomic back cushion
• Spinal decompression table

Surgical approach

When the symptoms of retrolisthesis become too handicapping despite a well-conducted conservative treatment, the only alternative available remains the surgery.

The intervention consists of fuse (weld) the two vertebrae (or more) sliding on top of each other thanks to the placement of screws and metal rods at the back of these vertebrae. This is called a « cervical arthrodesis » if performed at the neck, and lumbar arthrodesis for the lower back.

The nerve compression (causing the neurological symptoms of retrolisthesis) can be lifted by the simple fact of putting the displaced vertebra back in the correct position. But sometimes it is necessary to make nerve release gestures by removing bone, ligament or disc fragments (pieces of intervertebral discs) compressing the marrow or its roots independently of retrolisthesis.

For this type of intervention, a 5-8 day hospital stay is necessary. Some techniques called “minimally invasive” shorten the length of hospitalization and convalescence.

In most of the cases, the patient is lifted within 48 hours postoperatively, with or without a brace depending on his clinical condition. The recovery period varies from person to person. In general, the resumption of professional activities is done after three months (depending on occupation…).

A re-education is almost systematically performed after arthrodesis to allow the patient to regain mobility and muscle strength.

What about natural remedies?

Although they are not supported by solid scientific evidence, several natural products and home remedies are used to treat spinal pain, especially for their anti-inflammatory power. They are also used to speed healing following surgery.

Here is a non-exhaustive list of plants and essential oils that are effective in controlling pain and inflammation. The products are available on the site Country. Use promo code LOMBAFIT15 if you wish to obtain one of the following products, or any remedy aimed at relieving your symptoms and improving your quality of life:

• Turmeric. Thanks to its antioxidant and anti-inflammatory powers very powerful, turmeric is one of the most used plants in a culinary and therapeutic context. The composition of turmeric is essentially made of essential oils, vitamins (B1, B2, B6, C, E, K) and trace elements. But it is to its composition rich in curcumin and curcuminoids that we owe them and calm skin of this spice.
• Ginger. In addition to the special flavor it brings to the kitchen and its aphrodisiac properties, ginger is a root well known for its anti-inflammatory powers. the gingerol gives it its anti-inflammatory action. It is an active component acting on the inflammatory pain related to chronic joint inflammatory diseases, including rheumatoid arthritis, lupus, rheumatic diseases, etc. It has been proven that this active element is also effective in acting on the inflammation linked to arthritis and sciatica. Ginger also has other benefits thanks to its high potassium content and its richness in trace elements (calcium, magnesium, phosphorus, sodium) and vitamins (provitamin and vitamin B9).
• Omega-3s. Omega-3s are polyunsaturated fatty acids that play a very important role in the functioning of our body. They are provided by food in three natural forms: docosahexaenoic acid (DHA), alpha linolenic acid (ALA) and eicosapentaenoic acid (EPA). Beyond their action on the brain and the cardiovascular system, omega-3s prove very effective against inflammation. Indeed, they have the ability to act on the inflammatory mechanisms in osteoarthritis by slowing down cartilage destruction, thus they reduce the intensity of osteoarthritis pain. Sciatica, being most often linked to an inflammation secondary to a herniated disc, it can also respond to omega-3 provided it is consumed regularly. 
• Lemon eucalyptus. Eucalyptus is a plant most often used in the form of herbal tea or essential oil. She would have anti-inflammatory effects which give it the ability to act on the bone and joint pain in general and the pain of sciatica in particular.
• wintergreen. Wintergreen is a shrub from which a very interesting essential oil is extracted. It is one of the most used essential oils in aromatherapy. This oil extracted from the shrub bearing the same name, is used in massage to relieve sciatica and act like a analgesic. Indeed, it provides a heating effect thanks to its ability toactivate blood circulation locally.

How to prevent retrolisthesis?

Prevention of retrolisthesis relies on removing factors that increase stress on the spine. The goal is to avoid the development of this pathology in a person at risk, or its aggravation in a person who is a carrier.

Here are some of the preventive measures to adopt :

• Practice a regular physical activity including stretching and muscle-strengthening exercises to preserve spinal flexibility and increase spinal stability.
• Eat healthy et varied to provide calcium, phosphorus, vitamins and other elements necessary for the preservation of bone density.
• Maintain a good posture in all circumstances, mainly by avoiding prolonged static postures.
• Lose a few pounds in case of overweight/obesity and observe if this reduces the symptoms.
• Avoid wearing loads Lourdes.
• Avoid wearing heels Tops, especially if they cause pain.
• Avoid sports violent if they make symptoms worse (at least temporarily).

References

[1] M. Kawasaki, T. Tani, T. Ushida, and K. Ishida, “Anterolisthesis and retrolisthesis of the cervical spine in cervical spondylotic myelopathy in the elderly”, Journal of Orthopedic Science, flight. 12, n^o 3, p. 207-213, 2007.

[2] CH Jeon, JU Park, NS Chung, KH Son, YS Lee, and JJ Kim, “Degenerative retrolisthesis: is it a compensatory mechanism for sagittal imbalance? », The bone & joint journal, flight. 95, n^o 9, p. 1244-1249, 2013.

[3] U. Berlemann, DJ Jeszenszky, D. BÜHLERI, and J. Harms, “MECHANISMS OF RETROLISTHESIS IN THE I OVVER. LUMBAR SPINE A RADIOGRAPHIC STUDY”, Acta orthopedica belgica, flight. 65, p. 4‑1999, 1999.

[4] KK Kang, MS Shen, W. Zhao, JD Lurie, and AE Razi, “Retrolisthesis and lumbar disc herniation: a postoperative assessment of patient function”, The Spine Journal, flight. 13, n^o 4, p. 367-372, 2013.

[5] A. Ahmed, BH Mahesh, PK Shamshery, and A. Jayaswal, “Traumatic retrolisthesis of the L4 vertebra”, Journal of Trauma and Acute Care Surgery, flight. 58, n^o 2, p. 393-394, 2005.