Spondylolisthesis with gross osteoporosis
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Spondylolisthesis with gross osteoporosis

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Spondylolisthesis with gross osteoporosis Presentation Transcript

  • 1. Spondylolisthesis with Osteoporosis
  • 2. Patient Details IP Number: 716 Age: 34 y Gender: Female Weight: 49 kg Unit: Orthopaedics II DOA: 25/3/14 DOD: 31/3/14
  • 3. Reason for Admission: c/o lower backache since 2 months Patient was apparently normal 8 months back, when she developed lower backache, which was insidious in onset, gradually progressive, non radiating, digging type and not associated with tingling sensation.
  • 4. Pmhx: NS Fhx: NS Diet: Vegetarian Appetite: Normal Bowel & Bladder: Normal Sleep: Normal Allergies: NKA
  • 5. Spondylolisthesis with Osteoporosis
  • 6. DAY 1 PULSE: 82 bpm BP: 120/80 mmHg o/e: Spine Inspection: no visible spinal deformity no scars, swelling Palpation: spinous tenderness + over L4 and L5 spinous processes paraspinal spasm + no paraspinal tenderness B/L SI joint tenderness +
  • 7. SLR Examination Right Left SLR 45° 30° LF + + PF + + FHL 5/5 5/5 EHL 5/5 5/5 Reflex Examination Right Left Knee + + Ankle + + Plantar
  • 8. Adv: Hb, BC, CT, PT-INR, Blood Urea, Serum Creatinine, Urine Routine, X-ray Referred for Physiotherapy
  • 9. Treatment Chart Current Drugs Dose Route Freq Calcitriol + Calcium Carbonate + Zinc 0.25 mcg+ 500 mg + 7.5 mg PO 1-0-0 Nimesulide + Tizanidine 100 mg + 2 mg PO 1-0-1 Pyridoxine + Folic Acid + Alpha Lipoic acid PO 0-0-1
  • 10. DAY 2 BP: 130/70 mmHg Case reviewed GC fair Vitals stable CST
  • 11. Laboratory Investigations Hematology Hb 11.1 gm/dl (13.5 ± 2) WBC 7,500 cells/cu.mm (4000-11,000) DLC N 68% E 03% B 00% L 26% M 03% PLT 2.39 l/cu.mm (1.5-5) ESR 48 mm/hr (0-20) Biochemistry RBS 94 mg/dl (70-150) Urea 23 mg/dl (19-43) Secr 0.8 mg/dl (0.6-1.5) Urine Analysis Pus cells 2-4
  • 12. Electrolytes Na 132 mEq/L (133-144) K 4.1 mEq/L (3-5.5) Cl 102 mEq/L (95-105)
  • 13. X-RAY Report Lumbar X-ray shows first degree spondylolisthesis with gross osteoporosis
  • 14. Treatment Chart Current Drugs Dose Route Freq Calcitriol + Calcium Carbonate + Zinc 0.25 mcg+ 500 mg + 7.5 mg PO 1-0-0 Nimesulide + Tizanidine 100 mg + 2 mg PO 1-0-1 Pyridoxine + Folic Acid + Alpha Lipoic acid PO 0-0-1
  • 15. DAY 3 BP: 100/70 mmHg Case reviewed GC fair Vitals stable CST
  • 16. Treatment Chart Current Drugs Dose Route Freq Calcitriol + Calcium Carbonate + Zinc 0.25 mcg+ 500 mg + 7.5 mg PO 1-0-0 Nimesulide + Tizanidine 100 mg + 2 mg PO 1-0-1 Pyridoxine + Folic Acid + Alpha Lipoic acid PO 0-0-1
  • 17. DAY 4 BP: 100/62 mmHg Case reviewed GC fair Vitals stable Pre-operative instructions: Posted for epidural steroid tomorrow
  • 18. Drugs Dose Route Freq Alprazolam 0.5 mg PO HS Ranitidine 150 mg PO HS
  • 19. Treatment Chart Current Drugs Dose Route Freq Calcitriol + Calcium Carbonate + Zinc 0.25 mcg+ 500 mg + 7.5 mg PO 1-0-0 Nimesulide + Tizanidine 100 mg + 2 mg PO 1-0-1 Pyridoxine + Folic Acid + Alpha Lipoic acid PO 0-0-1
  • 20. DAY 5 BP: 110/60 mmHg Operative Procedure: Injection Methylprednisolone 80 mg + 6cc 0.25% bupivacaine
  • 21. Treatment Chart Current Drugs Dose Route Freq Calcitriol + Calcium Carbonate + Zinc 0.25 mcg+ 500 mg + 7.5 mg PO 1-0-0 Nimesulide + Tizanidine 100 mg + 2 mg PO 1-0-1 Pyridoxine + Folic Acid + Alpha Lipoic acid PO 0-0-1
  • 22. DAY 6 BP: 110/60 mmHg Post epidural 80% pain relief GC fair Vitals stable CST
  • 23. Treatment Chart Current Drugs Dose Route Freq Calcitriol + Calcium Carbonate + Zinc 0.25 mcg+ 500 mg + 7.5 mg PO 1-0-0 Nimesulide + Tizanidine 100 mg + 2 mg PO 1-0-1 Pyridoxine + Folic Acid + Alpha Lipoic acid PO 0-0-1
  • 24. DAY 7 BP: 110/60 mmHg Case reviewed GC fair Vitals stable Adv: Discharge
  • 25. Discharge Medications Current Drugs Dose Route Freq Calcium Carbonate + Vitamin D3 625 mg + 125 IU PO 1-0-0 Nimesulide + Tizanidine 100 mg + 2 mg PO SOS Pyridoxine + Folic Acid + Alpha Lipoic acid PO 0-0-1
  • 26. Pharmaceutical Care Plan
  • 27. Subjective Evidence • Low backache since 2 months Objective Evidence • Spinal examination • X-ray • Elevated ESR
  • 28. Final Diagnosis Spondylolisthesis with gross osteoporosis
  • 29. Goals of Therapy For Spondylolisthesis • To relieve the back pain (associated with an irritated nerve) • Restoring spinal flexibility and improving range of motion • Stopping the progression of slippage For Osteoporosis • To decrease pain • To prevent bone loss • To prevent fractures • To help the patient to return to the highest level of function and independence possible, while improving the overall quality of life
  • 30. Goals Achieved • 80% pain reduction was observed by day 6
  • 31. Specific Treatment Options For Spondylolisthesis • Conservative treatment NSAIDS Epidural steroid injections Brace Physical therapy
  • 32. For Osteoporosis • Non pharmacological therapy Calcium Vitamin D Exercise
  • 33. Monitoring Parameters Disease Specific X-ray BMD Drug Specific Serum calcium level Kidney Stones LFTs
  • 34. Problems Identified • BMD was not performed • Serum calcium and phosphorous levels were not determined • Use of nimesulide
  • 35. Patient Counseling about Disease Spondylolisthesis Osteoporosis
  • 36. Medication Counseling
  • 37. Lifestyle Modifications • Vit K • Mg • Phytoestrogen • Protein