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Spondylolisthesis as an entity for back pain agrasen hospital gondia vidarbha dr sandeep c agrawal www.drsandeepagrawal.com copy

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What is Spondylolisthesis?

Spondylolisthesis is a condition that affects the spine as we age. The condition occurs when one of the vertebras in the spine slips forward onto the one below it. Spondylolisthesis usually develops as we age and is a result of bones, joints, and ligaments in the spine weakening and being less able to hold the structure of the spinal column in proper alignment. Degenerative spondylolisthesis begins to show itself in patients over 50 years of age and becomes much more common in after the age of 65.


Spondylolisthesis can sometimes be treated non-surgically using block or steroid injections. In some cases it is necessary to perform a minimally invasive spinal fusion procedure, and prevent further deterioration.
Treatment

Treatment varies, depending on if the type of slip, the patient's age and symptoms, and whether pressure is being put on nerves. For those whose nerves are not affected by the vertebral slippage, treatment starts with non-surgical treatments like medication and physical therapy. Bracing may also be recommended. If symptoms are manageable and the slip is small, the treatment will likely be observation. Activity restrictions may be necessary for children, like abstaining from certain sports.

If the slip is more severe or symptoms of nerve compression are present, surgery may be recommended. Surgeries for this condition include spinal decompression, where bone is removed to make room for the nerve being compressed, or spinal fusion. These surgeries are often done at the same time.

Published in: Health & Medicine
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  • My Patient Care Philosophy 1. Open minds make for better answers. I will always try to avoid preconceived ideas about your diagnosis. I ask that you do too. We will meet without me knowing much about your orthopaedic issue. You may already have Googled your symptoms, received a “diagnosis” from friends, family, co-workers and perhaps even another doctor. If either of us comes to our meeting believing that we know the correct diagnosis and the only treatment plan, we may not arrive at the best plan for you. But if we work together, listen to each other and keep an open mind, we have a much better chance. I promise to keep an open mind. 2. I try to fit the treatment plan to my patient, not the patient to my plan. I have over 15 years of Orthopaedic experience. As a result, I have a lot of knowledge about Orthopaedics. However, I likely know very little about you, your priorities, fears, tolerance for various treatments with their risks and costs. Only you, and perhaps those close to you, do. Usually we are trying to improve your quality of life, not save it. There may not be a “right or wrong” treatment.only similarly equal options. I believe in a shared decision making policy. Therefore, I need your input so we can match the treatment to your goals. 3. A team is always better than one. Unfortunately recovering from an orthopaedic injury cannot be passive. I will need your help to get you better. Together we will develop a plan. I can guide you through,but I can’t carry it out alone. I will need you to be an active participant. At times you may be unsure, frustrated, tired and in pain. I will do my best to educate, reassure, motivate and make you as comfortable as is safely possible and appropriate, but I’ll need your help to do it. Your recovery will be a challenge but together we can overcome it. 4.Just because it’s broken (or torn), doesn’t mean we must operate. I’m a surgeon. I enjoy performing surgery. But just because something is broken or torn, doesn’t always mean surgery is required. We all have a tremendous capacity to heal. Sometimes “less is more” and all we need is some simpler treatments and time. Additionally, we are born with extra parts (hair, earlobes, Appendix and even our kidney comes to mind. We don’t always need everything looking and functioning perfectly to perform perfectly. Many professional and Olympic athletes have bones that are slightly misshapen and ligaments that are mildly loose. They perform at the highest level and so can you. You may want everything perfect, but it may not be needed to get you to your peak or to prevent further damage or future problems. If it does I will tell you. If not, I will let you know as well. 5. When used properly, Investigations and Reports can be helpful, When not, they’re not. Like any opinion, they are simply someones interpretation. What is on your report may or may not be what is actually present. At best the report is correct but it still does not necessarily determine treatment. I make my diagnosis by speaking with you, examining you, watching your response to treatment and when necessary reviewing any imaging studies or labs. Anyone can read a report and tell you what it says. I’ll read your study and tell you what I think. My Expertise : Arthroscopy of Shoulder, Knee, Elbow and Ankle Advanced arthroscopic knee reconstructions (ACL and other ligaments) Advanced arthroscopic shoulder reconstructions and repairs (Instability,Rotator cuff tears,Bankarts lesion and others) Shoulder replacements (Resurfacing, Total Shoulder and Reverse shoulder replacements) Elbow injuries and problems Joint Replacements Fracture and trauma advanced management Spine Surgeries Ankle injuries
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  • Why Choose Agrasen hospital For Orthopaedic Care? Whether you’re suffering from arthritis, recovering from a sports injury, or considering a knee replacement you can turn to Agrasen hospital for leading-edge orthopaedic care that meets your total needs including prevention, treatment and recovery. Best orthopaedic program Perform good number of lower extremity joint replacement Comprehensive, integrated orthopaedic services An exceptional patient experience. Conditions Treated & Facilities: From acute injuries to back pain to Arthroscopy to joint pain, Agrasen hospital offers comprehensive care for all types of conditions affecting your bones and joints, including: Arthritis Fractures & Trauma Surgery Hip Joint Knee Joint Shoulder Joint Spine & Back Pain Arthroscopy & Sports-related injuries Joint Replacement Surgeries Foot and ankle Conditions Hand, wrist and elbow Joint Osteoporosis Cerebral palsy Bone tumours Physiotherapy & Rehabilitation Pain management Paediatric Orthopaedics
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  • If a bone or joint problem is slowing you down, Agrasen hospital has a complete range of specialized orthopaedic care to help get you back in motion.
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Spondylolisthesis as an entity for back pain agrasen hospital gondia vidarbha dr sandeep c agrawal www.drsandeepagrawal.com copy

  1. 1. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Spondylolisthesis Visit us at: www.drsandeepagrawal.com www,agrasenortho.com Dr.Sandeep Agrawal Consultant Orthopedic Surgeon MS,DNB Agrasen Hospital Gondia Maharashtra India www.agrasenortho.com www.drsandeepagrawal.com drsandeep123@gmail.com 09960122234
  2. 2. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com - OVERVIEW!! - PATHOPHYSIOLOGY & TYPES! - CLINICAL PRESENTATION! - PHYSICAL EXAMINATION! - DIAGNOSIS! - DIAGNOSTIC TESTS! - DIFFERENTIAL DIAGNOSIS! - TREATMENT!! - SUMMARY
  3. 3. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Spondylolisthesis •Displacement of a cephalad vertebra on the adjacent caudal vertebra •Slipage : anterior, posterior and lateral 3 Spondylolisthesis is derived from the Greek words spondylo , meaning spine, and listhesis , meaning to slip or slide. OVERVIEW (definition) • Lead to a deformity of the spine as well as a narrowing of the spinal canal (central spinal stenosis) or compression of the exiting nerve roots (foraminal stenosis).
  4. 4. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com 4 OVERVIEW ( Anatomy ) Pars interarticulars Spinous process Articular process (inferior) OVERVIEW ( Anatomy)
  5. 5. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com OVERVIEW (Dermatomes)
  6. 6. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com 6 OVERVIEW (Dermatomes)
  7. 7. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Classification •Wiltse classification system – anatomy •Meyerding system- by degree of anterior translation
  8. 8. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com 8 It can be classified into 6 distinct categories as the following ( developed by Wiltse, Macnab, and Newman ): TYPES ( according to etiology ) ❑ Type I: Congenital spondylolisthesis ! ❑ Type II: Isthmic spondylolisthesis ! ❑ Type III: Degenerative spondylolisthesis ! ❑ Type IV: Traumatic spondylolisthesis ! ❑ Type V: Pathologic spondylolisthesis ! ❑ Type VI : Postsurgical
  9. 9. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com • characterized by presence of dysplastic sacral facet joints allowing forward translation of one vertebra relative to another. Type I: Congenital spondylolisthesis ! • Caused by the development of a stress fracture of the pars interarticularis. • It is also further divided into 3 subtypes : Type IIA , type IIB and type IIC . ! Type III: Degenerative spondylolisthesis It is commonly caused by intersegmental instability produced by facet arthropathy. Type II: Isthmic spondylolisthesis
  10. 10. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Type IV: Traumatic spondylolisthesis Caused by fracture or dislocation of the lumbar spine, not involving the pars ! Type VI : Postsurgical (iatrogenic) Type V: Pathologic spondylolisthesis. Caused by malignancy, infection, or other types of abnormal bone
  11. 11. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com • Heavy Athletic activities requiring predispose some athletes to developing pars defects. ! • Approximately 82% of cases of isthmic spondylolisthesis occur at L5-S1.  Another 11.3% occur at L4-L5. ! • Degenerative spondylolisthesis occurs more frequently with increasing age. ! • L4-L5 interspace is affected 6-10 more times than any other level. ! • Sacralization of L5 is frequently seen with L4-5 degenerative spondylolisthesis .
  12. 12. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com ! ! • Acute isthmic spondylolysis often occurs during the first and second decades of life. Most cases occur before the patient reaches age 15 years. ! • Younger patients are at higher risk than older patients for developing progressive spondylolisthesis. ! • But the risk for progression in adults is rare when the lesion is at L5.. Age
  13. 13. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Type I ( Dysplastic / congenital ) • Failure of formation of the anatomic elements of the lumbosacral facet joint • Axially oriented facet with dyplasia of the superior end plate of the sacrum • Intact pars interarticularis limited splippage < 30% -35 %
  14. 14. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Type II ( Isthmic ) • Presence of a defect in the pars interarticularis ( isthmus ) • Scotty dog sign • Secondary to repetitive microtrauma or a single trauma episode • Subtype A : defect in pars • Subtype B : defect in elongated pars • Subtype C : acute fracture of the pars
  15. 15. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com • Spondylolisthesis occurs when there’s bilateral defects in the vertebral pars intrarticulariss which permit the vertebral body to slip anteriorly. Usually occurs at level (L5,S1) ! • Spondylolysis is the most common cause for spondylolisthesis. It’s a unilateral or bilateral defect in the vertebral pars interarticularis result from stress fracture. PATHOPHYSIOLOGY
  16. 16. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Type II ( Isthmic ) • Alaskan Eskimos : 26 % • Hyperextension forces
  17. 17. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Type III ( Degenerative ) •Facet joint OA and Hypertrophic lig. flavum
  18. 18. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com 18 ! • spondylolysis typically is acquired as the bone "fatigues" from recurrent microtrauma during excessive lumbar hyperextension or repeated lumbar flexion and extension. • rebeated Hyperflextion and extension of the joints are more common in athletes. • (diving, weight lifting, wrestling and football)
  19. 19. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com • Spondylolysis progresses to spondylolisthesis in approximately 15% of cases. Progression to spondylolisthesis is correlated with persistent pain and lack of healing.
  20. 20. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com 6- Patients with degenerative spondylolisthesis (DSPL) are characterized by an increased pelvic tilt (PT) and decreased sacral slope (SS) than the control population, suggesting the presence of a pelvic compensation
  21. 21. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Type IV ( Posttraumatic ) •Trauma induce disrupt the posterior arch and its articulations other than pars interarticularis
  22. 22. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Type V ( Pathologic ) •Systemic disease associated : osteogenesis imperfecta, osteopetrosis, arthrogryposis, syphilis •Localized process : infection, neoplasm
  23. 23. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Type VI ( Postsurgical ) • Laminectomy induced instability • Direct disruption of the facet joint complex • Direct disruption of pars interarticularis • > 50 % posterior facet joint complex removal
  24. 24. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Meyerding classification • Anterior translation as a percentage of vertebral body on lateral view •Grade I : < 25 % •Grade II : 26-50% •Grade III : 51-75 % •Grade IV : 76 – 100 % •Grade V : > 100 % ( spondyloptosis ) Grade 1 Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Normal
  25. 25. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com 25 Grades ( Myerding Classification)
  26. 26. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Presentation and evaluation • Pain at the lumbosacrum junction may radiate to the buttock and posterior thigh but rare below the knee • Restricted motion of lumbar spine • Palpable step-off at L-S junction • Focal kyphosis at L-S junction
  27. 27. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com 1-Phalen-Dickson sign: ! bent-knee, hip-flexed posture with high-grade spondylolisthesis 2-One-legged hyperextension test (stork test): ! Use To differenation between spondylolysis (+) and spondylolisthesis(-) PHYSICAL EXAMINATION
  28. 28. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com With increasing slippage, the sacrum becomes relatively more vertical, impairing hip extension and compelling the patient to walk with a knee-flexed, hip-flexed gait 1-Phalen-Dickson sign:
  29. 29. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com A positive one-legged hyperextension test while standing on one leg and bending backward, pain is experienced in the ipsilateral back. 2-One-legged hyperextension test (stork test):
  30. 30. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com ! ! ! 1- Radiography: lateral view of lumbar spine is especially useful in detection Spondylolisthesis. ! 2- Computed Tomography: CT SCANNING axial or sagittal image of the lumbar spine can be performed with or without contrast enhancment. ! 3- Magnetic Resonance Imaging(MRI): has the distinct advantage of imaging of the spine in any plane. Typically, the axial and sagittal planes are used. ! ! DIAGNOSTEC TESTS
  31. 31. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com
  32. 32. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Spondylolisthesis. Oblique projection radiograph shows the presence of bilateral pars defects (arrows), with an appearance resembling a Scottie dog with a collar. (The collar is the pars defect.)
  33. 33. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com A) -Lateral lumbar spine. Note the pars defects (arrow) and anterior displacement of the L5 vertebra. B) -Oblique lumbar spine. Observe the clearly visible lucent collar (arrow).
  34. 34. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Sagittal CT reconstruction image shows the pars defect along with grade 1 spondylolisthesis. Spondylolisthesis. Axial CT image shows bilateral spondylolysis (arrows). Note elongation of the spinal canal at this level
  35. 35. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Image Diagnosis • AP + Lateral L-S views • Stress dynamic view (flexion and extension) - 4 mm Ant. Translation 100 Angulation • Both oblique view for R/O pars fracture
  36. 36. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com DIFFERENTIAL DIAGNOSIS ! !• Lumber facet-arthropathy . • Coccyx pain. • Mechanical low back pain . • Overuse Injury. • Lumber compression Fracture. • Lumber canal stenosis . • Lumbar disk herniation . ! ! !
  37. 37. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com • degenerative arthritis affecting the facet joints in the spine • Low back pain can radiate to gluteal, back of the thigh and rarely below the knee. • was no numbness, no muscle weakness and the reflexes were normal. • Stiffness • Poor posture • Radiography: CT and X-ray Lumber facet-arthropathy
  38. 38. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Axial CT ✓ marked osteophytosis and joint space narrowing ✓ severe osteoarthritis
  39. 39. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com • Coccydynia is inflammation localized to the tailbone pain and tenderness at coccyx. ! • The pain is often worsened by sitting. • Patient leaning against the buttocks ! • Radiography: CT and X-ray Coccyx pain
  40. 40. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Lateral radiograph (a) and sagittal CT reconstruction (b) demonstrating a fractured coccyx in a patient who was diagnosed with coccydynia following a ground-level fall 6 months earlier
  41. 41. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com • fracture of lumber spine due to trauma or pathological fracture in osteomyelitis. • Common in woman who is near or over age 50 . • Sudden back pain radiate to lower limb. numbness and motor weakness in lower limb if nerve roots is affected • Radiography: CT and X-ray Lumber compression Fracture
  42. 42. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com 42 • congenital narrowing of the lumbar spinal canal. • low back pain, • weakness, numbness, pain, and loss of sensation in the legs. • worse pain in standing or walking and backward. It is relieved by sitting and forward. • sphincteric function impairment. • Negative straight leg raising test • Radiography: X-ray, CT and MRI Lumbar canal stenosis
  43. 43. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Natural history • Multifactorial etiology • 91 % without treatment had lower back pain • 55 % had sciatica • 18 % had neurologic defect • 5 % progression and most in adolescent • Risk factor : slippage > 25% , early disc degeneration
  44. 44. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com TREATMENT! 1. Conservative . 2. Surgery and Complications 3. Complications !
  45. 45. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com ➢Treatment for spondylolisthesis depends on several factors, including the age and overall health of the person, the extent of the slip, and the severity of the symptoms. ! ! ➢Treatment most often is conservative and more severe spondylolisthesis might require surgery.
  46. 46. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Nonsurgical Rx •Mainstay of treatment at < 50 % slippage •Brace : goal to reduce hyperlodosis and stabilize motion •Physiotherapy • Specific training of muscle surrounding the spine
  47. 47. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com 47 ➢Surgery might be necessary if the vertebra continues to slip or if the pain is not relieved by conservative treatment and begins to interfere with daily activities. ! ➢The main goals of surgery for spondylolisthesis are: 1) to relieve the pain associated with an irritated nerve, 2) to stabilize the spine where the vertebra has slipped out of place, 3) and to increase the person’s ability to function. Surgical treatment
  48. 48. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Surgical Rx •Persistent symptoms (pain and neurologic deficits) affecting quality of life and progression of slip are indicated for surgical Rx. •MRI for further survey (pain source and stenosis )
  49. 49. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Surgical Rx ! ! • Instrumentation with fusion => better for immediate stability and fusion rate • Low-grade slip with lysis => arthrodesis alone better than decompression + fusion • High-grade slip => fusion in situ with good long term results. • Circumferential fusion (A+P) for good fusion if anterior defect or local kyphosis
  50. 50. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com 2. Fusion ➢ A spinal fusion is normally done immediately after laminectomy for spondylolisthesis. ➢ It is designed to fuse the two vertebrae into one bone and stop the slippage from worsening. ! ➢ The fusion is used to lock the vertebrae in place and stop movement between the vertebrae. ! • Types : A. Traditional Fusion B. Minimally invasive surgical spine fusion
  51. 51. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com 51 A. Traditional Fusion ! ✓ The vertebrae are affixed to one another using surgical instrumentation. ✓ Bone graft is then placed between the vertebrae allowing them to "fuse" together over time. ✓ This stabilizes the painful joint segment and relieves pressure from the painful spinal nerves Examples : 1. Postero-lateral fusion (PLF) 2. Posterior Lumbar Interbody Fusion(PLIF)
  52. 52. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com 1. posterolateral fusion (PLF) ➢ posterolateral fusion is the grandfather of fusion technique as it was developed just over 100 years ago. ➢ In a posterior approach to lumbar fusion, the surgeon makes an incision down the middle of the lower back. ➢ One of the criticisms of PLF is that it involves an extensive dissection (the stripping of muscle and fascia off of bone) of the adjacent transverse processes, facet(s) and sometimes lamina. ➢ After the decompression, the surgeon will place graft material along the sides of the vertebrae to stimulate bone growth. ➢ Titanium screws and rods are often used to provide immediate stability to the spine until a solid fusion has been achieved.
  53. 53. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com 2. Posterior Lumbar Interbody Fusion(PLIF): ➢ In this procedure, the problem vertebrae are fused from the anterior (front) and posterior (back). ➢ The surgeon works from the back of the spine and removes the disc between the problem vertebrae. ➢ Bone graft material is inserted from the back of the spine into the space between the two vertebrae where the disc was removed (the interbody space) ➢ Transpedicular instrumentation is attached to stabilize the motion segment while fusion occurs.
  54. 54. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Spondylolytic spondylolisthesis L4,5 L4 Pars fracture
  55. 55. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Degenerative Spondylolisthsis L4,5 with Spinal Stenosis
  56. 56. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Degenerative Spondylolisthsis L4,5 with Spinal Stenosis S/P OP
  57. 57. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com o Implant failure. o Pseudoarthrosis. o Nonunion. o Foot drop. o Spinal compression. o Acute bowel ischaemia Complications of surgical repair
  58. 58. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com - Spondylolisthesis is a forward or backward slippage of one vertebra on an adjacent vertebra. ! - Causes of spondylolisthesis include trauma, degenerative, tumor, and birth defects. ! - Symptoms of spondylolisthesis include lower back or leg pain, hamstring tightness, and numbness and tingling in the legs. ! - diagnosis is mainly based on imaging . ! - Most people with spondylolisthesis can be treated conservatively, without the need for surgery. ! - Patients who fail to improve with conservative treatment may be a candidate for surgery. SUMMARY
  59. 59. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Visit us at: www.drsandeepagrawal.com www,agrasenortho.com
  60. 60. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com This presentation is for doctors in general.! . Some graphics and jpeg files are taken from Google Image  to heighten the specific points in this presentation. ! • If there is any objection/or copyright violation, please inform drsandeep123@gmail.com for prompt deletion. ! • It is intended for use only by the doctors of orthopaedic surgery.! . Views expressed in this presentation are personal. • .For any confusion please contact the sole author for clarification. ! • Every body is allowed to copy or download and use the material best suited to him. ! Visit us at:! www.drsandeepagrawal.com! www,agrasenortho.com
  61. 61. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA  www.agrasenortho.com Visit us at:! www.drsandeepagrawal.com! www,agrasenortho.com

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