This document provides information about spondylolisthesis, including:
- It is the slippage of one vertebra over another, most commonly in the lumbar spine.
- It is usually caused by spondylolysis, a defect in the pars interarticularis.
- It is classified based on cause (isthmic, degenerative, etc.) and graded based on the percentage of slip.
- Symptoms vary but can include back pain and radiculopathy, with conservative care tried initially before considering surgery.
This document provides information about spondylolisthesis, including its anatomy, classification, presentation, diagnosis, and treatment. It defines spondylolisthesis as the slipping of one vertebra over another, most commonly between L4-L5 or L5-S1. It is classified into 5 types including dysplastic, isthmic, degenerative, traumatic, and pathological. Clinical presentation varies from being asymptomatic to back pain and sciatica. Diagnosis involves imaging like x-rays, CT, and MRI. Treatment ranges from conservative options like bracing and exercises to surgical options like decompression and fusion when conservative treatments fail.
This document contains a coursework cover sheet and assignment for a student named Hiren Divecha on the topic of defining and classifying spondylolisthesis and discussing the management of high grade slips. It includes a 2193 word essay on the topic with sections on the definition of spondylolisthesis, two common classification systems (Wiltse-Newman and Meyerding), and discussion of management approaches for high grade slips in children/adolescents and adults. References are provided at the end.
Spondylolisthesis is the anterior or posterior displacement of one vertebra over another. It is caused by defects in the pars interarticularis region which is the weakest part of the vertebra. Spondylolisthesis can be developmental, traumatic, pathological, or degenerative in nature. It is classified based on its etiology and grade. Low grade spondylolisthesis can be managed conservatively while high grade or progressive cases may require surgical intervention like fusion to prevent neurological complications.
1) Spondylolisthesis refers to the slippage of one vertebra over another, usually caused by a defect in the pars interarticularis bone.
2) It is commonly seen at the L5-S1 vertebrae and can be lytic, dysplastic, degenerative, post-traumatic, or pathological in nature.
3) Symptoms range from being asymptomatic to low back pain, muscle spasms, nerve root compression and neurological deficits. Surgery is considered for severe, progressive, or neurologically symptomatic cases.
This document provides information on spondylolisthesis, including its definition as the forward slippage of one vertebra on another, most commonly at L5-S1. It discusses relevant anatomy and classifications including developmental, isthmic, degenerative, and traumatic types. Imaging findings like the "scotty dog" sign are described. Management involves conservative options like rest and physical therapy or surgical decompression and fusion depending on symptoms and etiology.
The Vancouver Spine Care is founded by Dr. Dean Greenwood and Dr. Richard Hunter. Both the doctors are certified Cox technicians and have got more than 30 years of full time experience in the field of spine care. In case if you are looking for further information then feel free to contact us.
http://www.vancouverspinecarecentre.com
This document discusses spondylolisthesis, including:
- It defines spondylolisthesis as the forward slippage of one vertebra on its adjacent caudal segment.
- Several classification systems are described including the Wiltse, Newman and Macnab classification based on etiology and topography.
- Risk factors for slip progression include developmental spondylolisthesis with lysis, isthmic spondylolisthesis from repetitive loading, and increased pelvic tilt.
- Treatment involves conservative care with bracing or exercise initially. Surgical options include direct repair of pars defect, decompression with or without fusion and instrumentation depending on the grade of slippage.
Dr. Mahak Jain presented on spondylolisthesis. Key points include:
1) Spondylolisthesis is the forward translation of one vertebra on another, commonly caused by defects in the pars interarticularis known as spondylolysis.
2) It is classified based on etiology, with dysplastic, isthmic, degenerative, traumatic, and pathological types.
3) Treatment depends on factors like grade, symptoms, and etiology, ranging from conservative care to surgical options like decompression, fusion, and instrumentation.
4) Studies show surgery with fusion has better outcomes for pain and function than nonsurgical treatment or decompression alone for degenerative
This document provides information about spondylolisthesis, including its anatomy, classification, presentation, diagnosis, and treatment. It defines spondylolisthesis as the slipping of one vertebra over another, most commonly between L4-L5 or L5-S1. It is classified into 5 types including dysplastic, isthmic, degenerative, traumatic, and pathological. Clinical presentation varies from being asymptomatic to back pain and sciatica. Diagnosis involves imaging like x-rays, CT, and MRI. Treatment ranges from conservative options like bracing and exercises to surgical options like decompression and fusion when conservative treatments fail.
This document contains a coursework cover sheet and assignment for a student named Hiren Divecha on the topic of defining and classifying spondylolisthesis and discussing the management of high grade slips. It includes a 2193 word essay on the topic with sections on the definition of spondylolisthesis, two common classification systems (Wiltse-Newman and Meyerding), and discussion of management approaches for high grade slips in children/adolescents and adults. References are provided at the end.
Spondylolisthesis is the anterior or posterior displacement of one vertebra over another. It is caused by defects in the pars interarticularis region which is the weakest part of the vertebra. Spondylolisthesis can be developmental, traumatic, pathological, or degenerative in nature. It is classified based on its etiology and grade. Low grade spondylolisthesis can be managed conservatively while high grade or progressive cases may require surgical intervention like fusion to prevent neurological complications.
1) Spondylolisthesis refers to the slippage of one vertebra over another, usually caused by a defect in the pars interarticularis bone.
2) It is commonly seen at the L5-S1 vertebrae and can be lytic, dysplastic, degenerative, post-traumatic, or pathological in nature.
3) Symptoms range from being asymptomatic to low back pain, muscle spasms, nerve root compression and neurological deficits. Surgery is considered for severe, progressive, or neurologically symptomatic cases.
This document provides information on spondylolisthesis, including its definition as the forward slippage of one vertebra on another, most commonly at L5-S1. It discusses relevant anatomy and classifications including developmental, isthmic, degenerative, and traumatic types. Imaging findings like the "scotty dog" sign are described. Management involves conservative options like rest and physical therapy or surgical decompression and fusion depending on symptoms and etiology.
The Vancouver Spine Care is founded by Dr. Dean Greenwood and Dr. Richard Hunter. Both the doctors are certified Cox technicians and have got more than 30 years of full time experience in the field of spine care. In case if you are looking for further information then feel free to contact us.
http://www.vancouverspinecarecentre.com
This document discusses spondylolisthesis, including:
- It defines spondylolisthesis as the forward slippage of one vertebra on its adjacent caudal segment.
- Several classification systems are described including the Wiltse, Newman and Macnab classification based on etiology and topography.
- Risk factors for slip progression include developmental spondylolisthesis with lysis, isthmic spondylolisthesis from repetitive loading, and increased pelvic tilt.
- Treatment involves conservative care with bracing or exercise initially. Surgical options include direct repair of pars defect, decompression with or without fusion and instrumentation depending on the grade of slippage.
Dr. Mahak Jain presented on spondylolisthesis. Key points include:
1) Spondylolisthesis is the forward translation of one vertebra on another, commonly caused by defects in the pars interarticularis known as spondylolysis.
2) It is classified based on etiology, with dysplastic, isthmic, degenerative, traumatic, and pathological types.
3) Treatment depends on factors like grade, symptoms, and etiology, ranging from conservative care to surgical options like decompression, fusion, and instrumentation.
4) Studies show surgery with fusion has better outcomes for pain and function than nonsurgical treatment or decompression alone for degenerative
Spondylolisthesis is the slipping of one vertebra over another. It is commonly caused by dysplastic, isthmic, degenerative or traumatic conditions. It most often occurs at the L4-L5 or L5-S1 levels and presents with lower back pain, neurogenic claudication or radiculopathy. Imaging studies can classify and grade the spondylolisthesis. Conservative treatment includes rest, medications and physical therapy while surgical treatment is considered for progressive neurological deficits or severe, persistent pain.
The document discusses degenerative spondylolisthesis, including its definition, classification, risk factors, clinical presentation, imaging findings, non-operative and operative treatment options, and guidelines for treatment. Key points include that it most commonly affects L4-L5, is more common in females, clinical symptoms do not always correlate with radiographic progression, non-operative treatment is usually initial approach, and decompression with fusion may improve outcomes over decompression alone for single-level disease.
This document provides information on spondylolisthesis, including its definition, classification systems, etiology, natural history, clinical evaluation, radiographic findings, and management. Spondylolisthesis is defined as the slipping of one vertebra over another, most commonly of L5 over S1. It is classified based on etiology, including dysplastic, isthmic, degenerative, traumatic, and pathological types. Causes include developmental defects, stress fractures of the pars interarticularis, degeneration of the disc and facets, acute fractures, and bone diseases. Progression risks include young age, female sex, slip angle over 10 degrees, and sacral morphology. Evaluation involves history, exam looking for signs
This document discusses spondylolisthesis, a condition where one vertebra slips out of position over another. It can be caused by hereditary factors, trauma or degeneration. Symptoms range from none in children to back/leg pain and neurological issues in adults. Diagnosis involves imaging tests like x-rays, CT and MRI. Treatment options include conservative care, bracing or surgery like fusion to correct alignment and stop progression if symptoms are present or the slip is worsening. Surgical reduction may be needed for severe slips over 45 degrees or those causing neurological problems.
This document discusses different types of spondylolisthesis, including definitions, causes, classification, clinical presentation, imaging, and treatment options. It describes 5 types of spondylolisthesis classified based on etiology: dysplastic (Type I), isthmic or spondylolytic (Type II), degenerative (Type III), traumatic (Type IV), and pathologic (Type V). Conservative treatment includes medications, bracing, and physical therapy, while surgical options involve decompression with or without fusion to stabilize the spine. Traumatic listhesis is a rare condition that results from an acute fracture of posterior elements other than the pars interarticularis.
The document discusses spondylolisthesis, which refers to the slippage of one vertebra over another. It defines the different types of spondylolisthesis, which include congenital, isthmic, degenerative, traumatic, and pathologic. It also describes the pathophysiology, risk factors, clinical presentation, diagnostic tests, treatment options, and differential diagnosis of spondylolisthesis. The document provides detailed information on spondylolisthesis and aims to educate medical professionals on evaluating and managing this spinal condition.
This document discusses spondylolisthesis, defined as the anterior or posterior displacement of one vertebra on another. It describes classifications based on anatomy and etiology, radiological grading scales, clinical presentation, diagnostic imaging including X-rays, CT, MRI, and myelography. Treatment options are discussed including non-operative care with bracing and exercise, as well as surgical techniques such as decompression with or without fusion, interbody fusion approaches, reduction methods, instrumentation, and complications. Surgical treatment aims to prevent slip progression, stabilize the segment, correct deformity, relieve pain and reverse neurological deficits.
Spondylolisthesis is the forward or backward slipping of one vertebra over another. This document discusses various types and classifications of spondylolisthesis. The key classifications discussed are the Wiltse, Newman, and Macnab classification (which categorizes spondylolisthesis based on its location and cause), the Meyerding classification (which grades the severity of slip based on percentage of vertebral translation), and the Marchetti-Bartolozzi classification (which categorizes spondylolisthesis as developmental or acquired based on etiology). Risk factors for progression include young age at presentation, female gender, high slip angle, and high grade slip.
Spondyloptosis, or complete anterior translation of L5 below the sacrum, is a challenging pathology for spinal surgeons. There is no consensus on the ideal treatment. Surgical techniques proposed include complete or partial reduction with instrumentation and fusion, in situ fusion without reduction, and posterior osteotomies. The staged reduction method using external fixation described allows gradual reduction under assessment of neurological status to reduce risks. While reduction aims to restore alignment, it risks neurological injury, and in situ fusion is a safer alternative with similar outcomes when reduction is not necessary.
Spondylolisthesis is a condition where one vertebra slips out of position over another, usually involving L5 slipping over S1. It is caused by a defect in the pars interarticularis that causes instability. There are several types including isthmic, degenerative, traumatic, and dysplastic. Isthmic spondylolisthesis is the most common type under age 50 and involves a stress fracture of the pars interarticularis. Degenerative spondylolisthesis is most common over age 50 and does not involve a fracture. Symptoms include low back pain and leg pain or numbness. Treatment depends on severity but may include rest, bracing, physical therapy, or surgery.
Dr. Shankaragouda Patil presented on spondylolisthesis, beginning with its historical aspects defined by Herbiniaux in 1782 and the term being coined by Kilian in 1854. Spondylolisthesis is defined as the forward slippage of one vertebra on its adjacent caudal segment, often caused by a defect in the pars interarticularis. Wiltse, Newman, and Macnab's classification system categorizes spondylolisthesis into six types based on etiology. The natural history and progression of spondylolisthesis depends on factors like age, gender, degree of slippage, and type (developmental, isthmic, or degenerative).
This document discusses isthmic spondylolisthesis, a condition where one vertebra slips forward over another due to a stress fracture of the pars interarticularis. It provides details on a 41-year-old female patient presenting with left sciatica. It also reviews risk factors for complications with elevated BMI, classifications of spondylolisthesis, imaging findings, and surgical treatment options including fusion and fixation techniques.
This document discusses spondylolisthesis, which is the slippage of one vertebra over another. It begins by defining key terms related to spondylolisthesis and the spine. It then provides facts about the incidence and prevalence of spondylolisthesis. The document discusses the different types of spondylolisthesis identified by Leon Wiltse and the classification systems of Marchetti and Bartolozzi. It covers imaging techniques used to diagnose spondylolisthesis and notes that an osteophytic bone with subluxation can cause pain.
Isthmic spondylolisthesis is caused by a defect in the pars interarticularis that results in the anterior displacement of one vertebra on another. It commonly occurs at L5-S1 due to repetitive extension stresses. While often asymptomatic, it can cause back pain and radiculopathy. Diagnosis involves imaging like CT or MRI to view the pars defect. Treatment begins conservatively with rest, medication, and physical therapy. Surgery with fusion and instrumentation may be considered for persistent or progressive symptoms. Key factors like pelvic incidence correlate with severity and influence biomechanical stresses on the lumbar spine.
This document provides information about spondylolisthesis, including:
- It is a condition where one vertebra slips out of position, usually involving L5 slipping forward on S1.
- It can be caused by a defect in the pars interarticularis that allows slippage.
- Treatment options include non-operative measures like bracing or injections, or surgical options like decompression or fusion to correct the slippage and stabilize the spine.
- Surgical treatment is generally recommended for severe slips over 50% or when non-operative treatment fails to relieve pain. Different procedures are used depending on the severity and characteristics of the spondylolisthesis.
Fortis lecture High Grade SpondylolisthesisSumit2018
This document discusses the treatment of high grade spondylolisthesis. It considers whether reduction is necessary or if in situ fusion is preferable. Reduction carries risks of neurologic injury but may provide biomechanical advantages. The ideal treatment depends on factors like sagittal and pelvic balance, the presence of symptoms, and L5 transverse process size. For balanced sacropelvises with balanced spines, in situ fusion without reduction is often sufficient. Unbalanced cases may require reduction or circumferential fusion. The case presented involved a balanced patient who was treated successfully with in situ fusion using posterior instrumentation alone.
Diffuse idiopathic skeletal hyperostosis (DISH) is a common skeletal process of uncertain etiology found in 12 to 18% of Indian populations above 50 years. The primary manifestations of DISH are calcification and ossification of the spinal ligaments, as well as entheseal ossification within extraspinal sites
Osteochondrosis is a defect in bone growth that causes avascular necrosis. It commonly affects the epiphyses of joints in children and adolescents. Some specific types discussed include Legg-Calve-Perthes disease of the hip, Kohler's disease of the navicular bone, and Freiberg's infraction of the metatarsal heads. The document outlines the causes, presentations, classifications, imaging findings, and treatment options for various forms of osteochondrosis.
Spondylisthesis by dr venkata rama krishnaiah vapms copvrkv2007
Spondylolisthesis is the slippage of one vertebra over another. It is classified into six types based on cause, including dysplastic (congenital), isthmic, degenerative, traumatic, pathological, and iatrogenic. Isthmic spondylolisthesis is most common, typically occurring at L5-S1, and is often caused by a stress fracture of the pars interarticularis. Diagnosis involves x-rays and sometimes CT or MRI. Treatment includes rest, medications, bracing, physical therapy, and sometimes surgery to stabilize and fuse the vertebrae. Physical therapy focuses on core strengthening, stretching, and exercises to improve mobility and reduce pain.
Lumbar spinal stenosis perhaps is understood best as a clinicopathologic disorder: narrowing of the lumbar spinal canal and the nerve root canals (causing central and lateral recess stenosis respectively) typically is brought about by the process of osteoarthritis and leads to compression of the contents of the canals the neural and vascular structures, causing neurologic symptoms (typically low back and leg pain and lower limb numbness and weakness) that are intermittent, characteristically triggered by ambulation (ameliorated by pausing), and generally positional (aggravated by standing and eased by trunk flexion).
1. A skeletal dysplasia is a congenital abnormality of bone growth or development that results in structural abnormalities of the bones.
2. Making a diagnosis involves taking a thorough history and physical examination, including measurements of height, limb lengths, and facial features. Radiographs can identify which bones are affected.
3. Achondroplasia is the most common skeletal dysplasia, caused by a mutation in the FGFR3 gene, and is characterized by disproportionate short stature, frontal bossing, trident hands, genu varum, and foramen magnum stenosis.
Spondylolisthesis is the slipping of one vertebra over another. It is commonly caused by dysplastic, isthmic, degenerative or traumatic conditions. It most often occurs at the L4-L5 or L5-S1 levels and presents with lower back pain, neurogenic claudication or radiculopathy. Imaging studies can classify and grade the spondylolisthesis. Conservative treatment includes rest, medications and physical therapy while surgical treatment is considered for progressive neurological deficits or severe, persistent pain.
The document discusses degenerative spondylolisthesis, including its definition, classification, risk factors, clinical presentation, imaging findings, non-operative and operative treatment options, and guidelines for treatment. Key points include that it most commonly affects L4-L5, is more common in females, clinical symptoms do not always correlate with radiographic progression, non-operative treatment is usually initial approach, and decompression with fusion may improve outcomes over decompression alone for single-level disease.
This document provides information on spondylolisthesis, including its definition, classification systems, etiology, natural history, clinical evaluation, radiographic findings, and management. Spondylolisthesis is defined as the slipping of one vertebra over another, most commonly of L5 over S1. It is classified based on etiology, including dysplastic, isthmic, degenerative, traumatic, and pathological types. Causes include developmental defects, stress fractures of the pars interarticularis, degeneration of the disc and facets, acute fractures, and bone diseases. Progression risks include young age, female sex, slip angle over 10 degrees, and sacral morphology. Evaluation involves history, exam looking for signs
This document discusses spondylolisthesis, a condition where one vertebra slips out of position over another. It can be caused by hereditary factors, trauma or degeneration. Symptoms range from none in children to back/leg pain and neurological issues in adults. Diagnosis involves imaging tests like x-rays, CT and MRI. Treatment options include conservative care, bracing or surgery like fusion to correct alignment and stop progression if symptoms are present or the slip is worsening. Surgical reduction may be needed for severe slips over 45 degrees or those causing neurological problems.
This document discusses different types of spondylolisthesis, including definitions, causes, classification, clinical presentation, imaging, and treatment options. It describes 5 types of spondylolisthesis classified based on etiology: dysplastic (Type I), isthmic or spondylolytic (Type II), degenerative (Type III), traumatic (Type IV), and pathologic (Type V). Conservative treatment includes medications, bracing, and physical therapy, while surgical options involve decompression with or without fusion to stabilize the spine. Traumatic listhesis is a rare condition that results from an acute fracture of posterior elements other than the pars interarticularis.
The document discusses spondylolisthesis, which refers to the slippage of one vertebra over another. It defines the different types of spondylolisthesis, which include congenital, isthmic, degenerative, traumatic, and pathologic. It also describes the pathophysiology, risk factors, clinical presentation, diagnostic tests, treatment options, and differential diagnosis of spondylolisthesis. The document provides detailed information on spondylolisthesis and aims to educate medical professionals on evaluating and managing this spinal condition.
This document discusses spondylolisthesis, defined as the anterior or posterior displacement of one vertebra on another. It describes classifications based on anatomy and etiology, radiological grading scales, clinical presentation, diagnostic imaging including X-rays, CT, MRI, and myelography. Treatment options are discussed including non-operative care with bracing and exercise, as well as surgical techniques such as decompression with or without fusion, interbody fusion approaches, reduction methods, instrumentation, and complications. Surgical treatment aims to prevent slip progression, stabilize the segment, correct deformity, relieve pain and reverse neurological deficits.
Spondylolisthesis is the forward or backward slipping of one vertebra over another. This document discusses various types and classifications of spondylolisthesis. The key classifications discussed are the Wiltse, Newman, and Macnab classification (which categorizes spondylolisthesis based on its location and cause), the Meyerding classification (which grades the severity of slip based on percentage of vertebral translation), and the Marchetti-Bartolozzi classification (which categorizes spondylolisthesis as developmental or acquired based on etiology). Risk factors for progression include young age at presentation, female gender, high slip angle, and high grade slip.
Spondyloptosis, or complete anterior translation of L5 below the sacrum, is a challenging pathology for spinal surgeons. There is no consensus on the ideal treatment. Surgical techniques proposed include complete or partial reduction with instrumentation and fusion, in situ fusion without reduction, and posterior osteotomies. The staged reduction method using external fixation described allows gradual reduction under assessment of neurological status to reduce risks. While reduction aims to restore alignment, it risks neurological injury, and in situ fusion is a safer alternative with similar outcomes when reduction is not necessary.
Spondylolisthesis is a condition where one vertebra slips out of position over another, usually involving L5 slipping over S1. It is caused by a defect in the pars interarticularis that causes instability. There are several types including isthmic, degenerative, traumatic, and dysplastic. Isthmic spondylolisthesis is the most common type under age 50 and involves a stress fracture of the pars interarticularis. Degenerative spondylolisthesis is most common over age 50 and does not involve a fracture. Symptoms include low back pain and leg pain or numbness. Treatment depends on severity but may include rest, bracing, physical therapy, or surgery.
Dr. Shankaragouda Patil presented on spondylolisthesis, beginning with its historical aspects defined by Herbiniaux in 1782 and the term being coined by Kilian in 1854. Spondylolisthesis is defined as the forward slippage of one vertebra on its adjacent caudal segment, often caused by a defect in the pars interarticularis. Wiltse, Newman, and Macnab's classification system categorizes spondylolisthesis into six types based on etiology. The natural history and progression of spondylolisthesis depends on factors like age, gender, degree of slippage, and type (developmental, isthmic, or degenerative).
This document discusses isthmic spondylolisthesis, a condition where one vertebra slips forward over another due to a stress fracture of the pars interarticularis. It provides details on a 41-year-old female patient presenting with left sciatica. It also reviews risk factors for complications with elevated BMI, classifications of spondylolisthesis, imaging findings, and surgical treatment options including fusion and fixation techniques.
This document discusses spondylolisthesis, which is the slippage of one vertebra over another. It begins by defining key terms related to spondylolisthesis and the spine. It then provides facts about the incidence and prevalence of spondylolisthesis. The document discusses the different types of spondylolisthesis identified by Leon Wiltse and the classification systems of Marchetti and Bartolozzi. It covers imaging techniques used to diagnose spondylolisthesis and notes that an osteophytic bone with subluxation can cause pain.
Isthmic spondylolisthesis is caused by a defect in the pars interarticularis that results in the anterior displacement of one vertebra on another. It commonly occurs at L5-S1 due to repetitive extension stresses. While often asymptomatic, it can cause back pain and radiculopathy. Diagnosis involves imaging like CT or MRI to view the pars defect. Treatment begins conservatively with rest, medication, and physical therapy. Surgery with fusion and instrumentation may be considered for persistent or progressive symptoms. Key factors like pelvic incidence correlate with severity and influence biomechanical stresses on the lumbar spine.
This document provides information about spondylolisthesis, including:
- It is a condition where one vertebra slips out of position, usually involving L5 slipping forward on S1.
- It can be caused by a defect in the pars interarticularis that allows slippage.
- Treatment options include non-operative measures like bracing or injections, or surgical options like decompression or fusion to correct the slippage and stabilize the spine.
- Surgical treatment is generally recommended for severe slips over 50% or when non-operative treatment fails to relieve pain. Different procedures are used depending on the severity and characteristics of the spondylolisthesis.
Fortis lecture High Grade SpondylolisthesisSumit2018
This document discusses the treatment of high grade spondylolisthesis. It considers whether reduction is necessary or if in situ fusion is preferable. Reduction carries risks of neurologic injury but may provide biomechanical advantages. The ideal treatment depends on factors like sagittal and pelvic balance, the presence of symptoms, and L5 transverse process size. For balanced sacropelvises with balanced spines, in situ fusion without reduction is often sufficient. Unbalanced cases may require reduction or circumferential fusion. The case presented involved a balanced patient who was treated successfully with in situ fusion using posterior instrumentation alone.
Diffuse idiopathic skeletal hyperostosis (DISH) is a common skeletal process of uncertain etiology found in 12 to 18% of Indian populations above 50 years. The primary manifestations of DISH are calcification and ossification of the spinal ligaments, as well as entheseal ossification within extraspinal sites
Osteochondrosis is a defect in bone growth that causes avascular necrosis. It commonly affects the epiphyses of joints in children and adolescents. Some specific types discussed include Legg-Calve-Perthes disease of the hip, Kohler's disease of the navicular bone, and Freiberg's infraction of the metatarsal heads. The document outlines the causes, presentations, classifications, imaging findings, and treatment options for various forms of osteochondrosis.
Spondylisthesis by dr venkata rama krishnaiah vapms copvrkv2007
Spondylolisthesis is the slippage of one vertebra over another. It is classified into six types based on cause, including dysplastic (congenital), isthmic, degenerative, traumatic, pathological, and iatrogenic. Isthmic spondylolisthesis is most common, typically occurring at L5-S1, and is often caused by a stress fracture of the pars interarticularis. Diagnosis involves x-rays and sometimes CT or MRI. Treatment includes rest, medications, bracing, physical therapy, and sometimes surgery to stabilize and fuse the vertebrae. Physical therapy focuses on core strengthening, stretching, and exercises to improve mobility and reduce pain.
Lumbar spinal stenosis perhaps is understood best as a clinicopathologic disorder: narrowing of the lumbar spinal canal and the nerve root canals (causing central and lateral recess stenosis respectively) typically is brought about by the process of osteoarthritis and leads to compression of the contents of the canals the neural and vascular structures, causing neurologic symptoms (typically low back and leg pain and lower limb numbness and weakness) that are intermittent, characteristically triggered by ambulation (ameliorated by pausing), and generally positional (aggravated by standing and eased by trunk flexion).
1. A skeletal dysplasia is a congenital abnormality of bone growth or development that results in structural abnormalities of the bones.
2. Making a diagnosis involves taking a thorough history and physical examination, including measurements of height, limb lengths, and facial features. Radiographs can identify which bones are affected.
3. Achondroplasia is the most common skeletal dysplasia, caused by a mutation in the FGFR3 gene, and is characterized by disproportionate short stature, frontal bossing, trident hands, genu varum, and foramen magnum stenosis.
This document discusses spondylolisthesis, including its anatomy, classification, natural history, and management. Some key points include:
- Spondylolisthesis is the forward translation of one vertebra on another, often caused by a defect in the pars interarticularis. It is classified by its cause and severity.
- Symptoms range from low back pain to neurological deficits depending on grade. Imaging helps assess severity and complications.
- Conservative care focuses on symptom relief but surgery may be needed for progressive slippage, deformity, or neurological problems.
- Surgical options include decompression with or without fusion to improve stability. Fusion techniques include posterolateral, anterior, or circumferential
Spondylolisthesis is a condition where one vertebra slips out of position over another, usually involving L5 slipping forward over S1. It is caused by problems or defects in the pars interarticularis bone that connects the vertebrae. Spondylolisthesis can be classified based on its underlying cause, including dysplastic, isthmic, degenerative, traumatic, or pathological types. Common symptoms include low back pain and leg pain or numbness that worsens with activity. Diagnosis involves MRI or CT imaging to identify defects in the bone. Treatment options range from conservative measures like bracing or physical therapy for mild cases to spinal fusion surgery for more severe or symptomatic cases.
1) Spondylolisthesis is the forward slippage of one vertebra over another, usually occurring at L5-S1. It is commonly caused by defects in the pars interarticularis (spondylolysis), which allows stress fractures and slippage.
2) Common symptoms include low back pain exacerbated by movement and radiating pain or numbness in the legs. Physical exam may reveal tenderness over the slipped vertebrae, muscle spasms, and limited flexion.
3) Diagnosis is made through imaging like x-rays, CT, or MRI. X-rays can grade the percentage of slippage. CT and MRI better visualize defects and any impinge
1. The document discusses various skeletal and limb anomalies that can be detected on prenatal ultrasound, including skeletal dysplasias, dysostoses, and disruptions.
2. Some of the most common skeletal dysplasias discussed are achondroplasia, achondrogenesis, osteogenesis imperfecta, and thanatophoric dysplasia.
3. Ultrasound findings of various anomalies are provided, along with descriptions of specific conditions like achondroplasia, achondrogenesis, osteogenesis imperfecta, and thanatophoric dysplasia. Prognosis and inheritance patterns are also summarized for some conditions.
Spondylolisthesis is the forward slippage of one vertebra over another and most commonly occurs between L4-L5 or L5-S1. It can be caused by developmental abnormalities, stress fractures of the pars interarticularis, degeneration of the disc and facets, trauma or tumors. Symptoms include lower back pain and sciatica. Conservative treatment involves rest and bracing while surgery is indicated for progressive, high grade or neurologically compressive slips. Surgical options include fusion with or without instrumentation to reduce the slip and decompress the nerves.
Developmental dysplasia of the hip (DDH) is a spectrum of disorders involving abnormal development of the hip joint that may present as dysplasia, subluxation, or dislocation. It results from excessive laxity of the hip capsule allowing the femoral head to slip out of the acetabulum. DDH is diagnosed through clinical examination including Ortolani and Barlow's tests in infants, and imaging such as ultrasound and x-rays. Treatment depends on the degree of hip involvement and age of presentation, ranging from bracing to closed or open reduction. Screening of newborns is important for early detection and management to prevent long-term complications.
The document discusses different types of spinal curvature abnormalities including kyphosis, lordosis, and scoliosis. It defines each condition and describes their causes, symptoms, diagnostic tests, and treatment options. There are three main types of kyphosis - postural, Scheuermann's, and congenital. Lordosis is an inward curvature of the lumbar or cervical spine that can be caused by factors like poor posture or congenital abnormalities. Scoliosis is a lateral curvature of the spine that can be idiopathic, congenital, or neuromuscular in origin. Treatment depends on the underlying cause but may include exercises, bracing, or corrective surgery.
Spondylolisthesis refers to the forward displacement of one vertebral body over another, most commonly occurring at L5 over S1. It is classified based on etiology, with isthmic spondylolisthesis being the most common type caused by pars interarticularis defects. Symptoms include leg or back pain, numbness, and weakness. Treatment depends on the severity of the slip and symptoms, ranging from observation to surgery to decompress nerves or fuse vertebrae.
1) Spondylolisthesis is the slipping of one vertebra over another, usually caused by a defect in the pars interarticularis. It is classified based on its etiology and degree of slip.
2) Symptoms depend on the severity and include back pain, hamstring tightness, and sciatica. Examination may reveal a step in the back, tenderness over the pars defect, and limited back movement.
3) Imaging shows the degree of slip and any pars defect. Treatment focuses on pain relief through non-operative measures like physiotherapy initially, with surgery considered for more severe cases.
1) Spondylolisthesis is the slipping of one vertebra over another, usually caused by a defect in the pars interarticularis. It is classified based on its etiology and degree of slip.
2) Symptoms depend on the severity and include back pain, hamstring tightness, and sciatica. Examination may reveal a step in the back, tenderness over the pars defect, and limited back movement.
3) Imaging shows the degree of slip. Treatment focuses on pain relief through non-operative measures like physiotherapy. Surgery is considered if conservative treatment fails or neurological symptoms are present.
Cervical spondylosis is a degenerative condition affecting the cervical spine that commonly occurs with aging. As the cervical discs lose hydration and height, bone spurs and other degenerative changes can occur that result in compression of nerves or the spinal cord. While aging is the primary risk factor, repetitive neck movements from activities like texting or occupations involving manual labor can also contribute. Common symptoms include neck pain and stiffness, headaches, arm or hand numbness, weakness or tingling. Diagnosis involves physical examination and imaging tests like x-rays or MRI to identify the areas of involvement and damage.
Spondylolisthesis is a condition where one vertebra slips over the vertebra below it. It can be caused by defects in the bone (congenital or acquired) or degeneration. Imaging like x-rays, CT, and MRI are used to classify and evaluate the spondylolisthesis. Patients experience back pain that worsens with activity and improves with rest. Treatment depends on the severity and cause of the spondylolisthesis.
Recurrent posterior shoulder instability is an uncommon condition. It is often unrecognized, leading to incorrect diagnoses, delays in diagnosis, and even missed diagnoses. Posterior instability encompasses a wide spectrum of pathology, ranging from unidirectional posterior subluxation to multidirectional instability to locked posterior dislocations. Nonsurgical treatment of posterior shoulder instability is successful in most cases; however, surgical intervention is indicated when conservative treatment fails. For optimal results, the surgeon must accurately define the pattern of instability and address all soft-tissue and bony injuries present at the time of surgery. Arthroscopic treatment of posterior shoulder instability has increased application, and a variety of techniques has been described to manage posterior glenohumeral instability related to posterior capsulolabral injury. For more shoulder surgery and shoulder instability studies, visit Dr. Millett, The Steadman Clinic, Vail Colorado http://drmillett.com/shoulder-studies
This document discusses intervertebral disc herniation. It begins by describing the anatomy of the lumbar spine motion segment and intervertebral disc. It then discusses the causes, risk factors, symptoms, diagnosis and management of intervertebral disc herniation. Common locations for herniation are the L4-L5 and L5-S1 discs. Symptoms can include back pain and radicular leg pain. Diagnosis involves physical exam, imaging like MRI, and ruling out other conditions. Management includes conservative options like physical therapy and injections initially. Surgery is considered if conservative options fail or if neurological deficits are present. Microdiscectomy is a common surgical procedure for disc herniation.
T medical prefixes and suffixes alan moelleken mdAlan Moelleken
Various medical terms focused on prefixes and suffixes for medical terms. Source is wikipedia, useful to master all medical terms from all sources to be masterful in all areas of medicine from practice to law, legal, expert witness for jury, trials, antitrust suits and all other areas.
I medical prefixes and suffixes alan moelleken mdAlan Moelleken
Various medical terms focused on prefixes and suffixes for medical terms. Source is wikipedia, useful to master all medical terms from all sources to be masterful in all areas of medicine from practice to law, legal, expert witness for jury, trials, antitrust suits and all other areas.
Notes and references alan moelleken md lawsuit terms cottage hospital santa b...Alan Moelleken
These documents are for inquiry into medical terms. They are basic and do not represent the expanding knowledge of medical terms, anti-trust, jury lawsuits, trial cases and legal and medical case law in courts.
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These documents are for inquiry into medical terms. They are basic and do not represent the expanding knowledge of medical terms, anti-trust, jury lawsuits, trial cases and legal and medical case law in courts.
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Dr. Alan Moelleken is an orthopedic spine surgeon who specializes in spine treatment and orthopedic surgery. He received his medical degree from the University of Pennsylvania School of Medicine and completed his internship, residency, and fellowship at UCLA and NYU. Dr. Moelleken is board certified in orthopedic surgery by the American Board of Orthopaedic Surgery. He is affiliated with professional societies including the American Academy of Orthopaedic Surgery and North American Spine Society. Dr. Moelleken's office is located in Santa Barbara, California and he maintains a website with information on various spine conditions and treatments.
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These documents are for inquiry into medical terms. They are basic and do not represent the expanding knowledge of medical terms, anti-trust, jury lawsuits, trial cases and legal and medical case law in courts.
Notes and references alan moelleken md lawsuit terms cottage hospital santa b...Alan Moelleken
These documents are for inquiry into medical terms. They are basic and do not represent the expanding knowledge of medical terms, anti-trust, jury lawsuits, trial cases and legal and medical case law in courts.
Alan moelleken md lawsuit terms medical terminology Alan Moelleken
These documents are for inquiry into medical terms. They are basic and do not represent the expanding knowledge of medical terms, anti-trust, jury lawsuits, trial cases and legal and medical case law in courts.
Alan moelleken-md-santa-barbara-spine ortho-iatrogenic-deformities-scanAlan Moelleken
I'm providing this for informational purposes only in the medical, law, lawsuit, anti-trust, expert witness field. This is only for inquiry education use. Not a final determination of any legal term, lawsuit opinion, medical diagnosis by Alan Moelleken MD, Cottage Hospital, Santa Barbara, California.
Alan moelleken-md-santa-barbara-spine ortho-cardiac-arrestAlan Moelleken
I'm providing this for informational purposes only in the medical, law, lawsuit, anti-trust, expert witness field. This is only for inquiry education use. Not a final determination of any legal term, lawsuit opinion, medical diagnosis by Alan Moelleken MD, Cottage Hospital, Santa Barbara, California.
Alan moelleken-md-santa-barbara-spine ortho cardiac arrest caused by reperfus...Alan Moelleken
I'm providing this for informational purposes only in the medical, law, lawsuit, anti-trust, expert witness field. This is only for inquiry education use. Not a final determination of any legal term, lawsuit opinion, medical diagnosis by Alan Moelleken MD, Cottage Hospital, Santa Barbara, California.
Alan moelleken-md-santa-barbara-curriculum vitae santa barbara caAlan Moelleken
I'm providing this for informational purposes only in the medical, law, lawsuit, anti-trust, expert witness field. This is only for inquiry education use. Not a final determination of any legal term, lawsuit opinion, medical diagnosis by Alan Moelleken MD, Cottage Hospital, Santa Barbara, California.
Alan moelleken-md-santa-barbara-spine ortho-iatrogenic-deformities-scanAlan Moelleken
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Alan moelleken-md-santa-barbara-spine ortho-cardiac-arrestAlan Moelleken
This case report describes a 43-year-old woman who experienced cardiac arrest and multiple organ failure after undergoing surgery to release a tense lumbar paraspinal muscle compartment. During surgery, dusky and poorly perfused muscle herniated from the compartment upon release, indicating it had been ischemic. Postoperatively, the patient developed acidosis, hyperkalemia, hypotension, and progressed to cardiac arrest. She required prolonged intensive care support for cardiovascular, respiratory, renal and coagulation dysfunction, but eventually recovered. The authors conclude she experienced ischemia-reperfusion syndrome caused by release of the tense paraspinal compartment, which has not been previously reported but can cause serious systemic effects similar to compartment syndromes in other locations.
Alan moelleken-md-santa-barbara-spine ortho cardiac arrest caused by reperfus...Alan Moelleken
This case report describes a 43-year-old woman who experienced cardiac arrest and multiple organ failure after undergoing surgery to release a tense lumbar paraspinal compartment. The compartment syndrome developed after she fell two stories. Although her health was previously good, she experienced decompensation after the surgery that was concluded to be caused by ischemia-reperfusion syndrome. Ischemia-reperfusion syndrome occurs when blood flow is restored to ischemic tissue, causing cellular injury and systemic effects. This is the first reported case of a paraspinal compartment syndrome initiating ischemia-reperfusion injury.
Alan moelleken-md-santa-barbara-curriculum vitae santa barbara caAlan Moelleken
This document is Alan Moelleken's curriculum vitae. It summarizes his education, including medical degrees from the University of Pennsylvania School of Medicine and University at Albany. It also lists his professional training, certifications, licenses, appointments, publications, presentations, memberships and more than 30 years of experience as a spine and orthopedic surgeon in Santa Barbara, California.
Alan moelleken-md-santa-barbara-carpal tunnel syndromeAlan Moelleken
Carpal tunnel syndrome is a condition caused by compression of the median nerve as it passes through the carpal tunnel at the wrist. It causes numbness, tingling, and burning pain in the hand and fingers. The main risk factors are repetitive hand and wrist motions, obesity, diabetes, hypothyroidism, and pregnancy. It is diagnosed based on symptoms and nerve conduction tests. Treatments include splinting, corticosteroid injections, and carpal tunnel release surgery if more conservative options fail.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
acne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticals
Alan moelleken-md-santa-barbara-spondylolisthesis
1. Spondylolisthesis
From Wikipedia, the free encyclopedia
Not to be confused with spondylosis, spondylitis, or spondylolysis.
Spondylolisthesis
Classification and external resources
X-ray of the lateral lumbar spine with a grade III
spondylolisthesis at the L5-S1 level.
ICD-10
M43.1, Q76.2
2. ICD-9
738.4, 756.12
OMIM
184200
DiseasesDB
12318
MedlinePlus
001260
eMedicine
radio/651
MeSH
D013168
Spondylolisthesis is the anterior or posterior displacement of a vertebra or the vertebral column in relation
to the vertebrae below. The variant "listhesis," resulting from misdivision of this compound word, is
sometimes applied in conjunction with scoliosis.[1] These "slips" (aka "step-offs") occur most commonly in
the lumbar spine. Spondylolysis (a defect or fracture of the pars interarticularis of the vertebral arch) is the
most common cause of spondylolisthesis. This is not to be confused with a slipped disc, where one of the
spinal discs in between the vertebrae has ruptured.
A hangman's fracture is a specific type of spondylolisthesis where the C2 vertebra is displaced anteriorly
relative to the C3 vertebra due to fractures of the C2 vertebra's pedicles.
Contents
1 Classification
o 1.1 Grading
2 Signs and symptoms
o 2.1 Low-grade isthmic
o 2.2 High-grade isthmic
o 2.3 Degenerative
3 Pathophysiology
4 Treatment
o 4.1 Conservative management
o 4.2 Surgical
4.2.1 Low-grade isthmicspondylolisthesis
4.2.2 High-grade isthmicspondylolisthesis
5 Prognosis
6 History
7 See also
8 References
9 External links
Classification
Spondylolisthesis is officially categorized into five different types:. [2][3]
Dysplasticspondylolisthesis is a rare congenital spondylolisthesis occurring because of a
malformation of the lumbosacral junction resulting in small, incompetent facet joints.[citation needed]
3. X-ray picture of a grade 1 isthmicspondylolisthesis at L4-5
Isthmicspondylolisthesis is the most common form of spondylolisthesis. Isthmicspondylolisthesis
(also called spondylolyticspondylolisthesis) is a common condition with a reported prevalence of
5–7 percent in the US population. A slip or fracture of the intravertebral joint is usually acquired
between the ages of 6 and 16 years, but remains unnoticed until adulthood. Roughly 90 percent of
these isthmic slips are low-grade (less than 50 percent slip) and 10 percent are high-grade (greater
than 50 percent slip).[3]
Degenerativespondylolisthesis is a disease of the older adult that develops as a result of facet
arthritis and joint remodeling. Joint arthritis, and ligamentumflavum weakness, may result in
slippage of a vertebrae. Degenerative forms are more likely to occur in women, persons older than
fifty, and African-Americans.[3]
Traumaticspondylolisthesis is very rare and results from acute fractures in various areas of the
neural arch, other than the pars.[4]
Pathologicspondylolisthesis has been associated with damage to the posterior elements[which?] from
metastases or metabolic bone disease. These slips have been reported in cases of Paget's disease of
bone, tuberculosis, giant-cell tumors, and tumor metastases.[citation needed]
Grading
The most common grading system for spondylolisthesis is the Meyerding grading system for severity of
slip. The system categorizes severity based upon measurements on lateral X-ray of the distance from the
posterior edge of the superior vertebral body to the posterior edge of the adjacent inferior vertebral body.
This distance is then reported as a percentage of the total superior vertebral body length:
Grade 1 is 0–25 percent
Grade 2 is 25–50 percent
Grade 3 is 50–75 percent
Grade 4 is 75–100 percent
Over 100 percent is Spondyloptosis, when the vertebra completely falls off the supporting
vertebra.[citation needed]
Signs and symptoms
General stiffening of the back and a tightening of the hamstrings, with a resulting change in both posture
and gait. A leaning-forward or semi-kyphotic posture may be seen, due to compensatory changes. A
"waddle" may be seen in more advanced causes, due to compensatory pelvic rotation due to decreased
lumbar spine rotation. A result of the change in gait is often a noticeable atrophy in the gluteal muscles due
to lack of use.[citation needed]
4. MRI of L5-S1 Spondylolisthesis
Generalized lower-back pain may also be seen, with intermittent shooting pain from the buttocks to the
posterior thigh, and/or lower leg via the sciatic nerve. Additional symptoms may include tingling and
numbness. Coughing and sneezing can intensify the pain. An individual may also note a "slipping
sensation" when moving into an upright position. Sitting and trying to stand up may be painful and
difficult.[citation needed]
Low-grade isthmic
Isthmicspondylolisthesis refers to spondylolisthesis due to degeneration of the pars interarticularis[2] When
symptomatic, patients with symptomatic low-grade (<50 percent slippage) isthmicspondylolisthesis
typically present with activity-related back pain and often with radicular symptoms as well. [citation needed]
Patients with low grade spondylolisthesis are usually young adults (90 percent adults and 10 percent
adolescents) who present with low back pain and often with radiculopathy. High grade spondylolisthesis
may also present with back pain, but may also present with cosmetic deformity, hamstring tightness,
radiculopathy, abnormal gait, or it may be asymptomatic.[5]
High-grade isthmic
5. X-ray of a grade 4 spondylolisthesis at L5-S1 with spinal misalignment indicated
High-grade isthmicspondylolisthesis and dysplasticspondylolisthesis are regarded as separate clinical
entities from low-grade isthmic slips. High-grade slips are defined as those with greater than 50 percent
forward displacement. These slips are also accompanied by a significant amount of lumbosacralkyphosis,
which is forward bending of the L5 vertebral body over the sacral promontory. Rounding of the sacral body
and trapezoidal deformation of L5 are also common features. High-grade slips are much rarer than lowgrade slips, representing less than 10 percent of all isthmic slips, and the vast majority present during
adolescence, most during the early teenage years.[citation needed]
Unlike low-grade slips, many patients present without pain. Instead symptoms like bodily deformity,
neurologic abnormalities, tight hamstrings, and abnormal gait are often the reason for consultation. [citation
needed]
Degenerative
Patients with isthmicspondylolisthesis almost universally have a neural arch defect, meaning widening of
the central spinal canal at the level of the slip. In contrast, in degenerative spondylolisthesis the forward
translation of the vertebral body also causes narrowing of the central spinal canal at the level of the slip,
termed the "napkin ring effect" depecting the spinal canal as a series of napkin rings with one of the rings
slid forward in comparison to the others. The classic symptomology of patients with symptomatic
degenerative spondylolisthesis are similar to those with symptomatic lumbar spinal stenosis; either
neurogenicclaudication or radiculopathy (either unilateral or bilateral radiculopathy) with or without low
back pain.[citation needed]
Neurogenicclaudication is thought to result from central canal narrowing that is exacerbated by the listhesis
(forward slip). The classic symptoms of neurogenicclaudication are bilateral (both legs) posterior leg pain
that worsens with activity, but is relieved by sitting or forward bending.
Pathophysiology
This section needs additional citations for verification. Please help improve this article by
adding citations to reliable sources. Unsourced material may be challenged and removed.
(December 2008)
6. In the late 1890s, several cadaver studies demonstrated the characteristic pars defect of
isthmicspondylolisthesis, leading to many different theories concerning the etiology of the defect. The first
theory proposed a failure of ossification during embryonic development, leading to a pars defect at birth,
which then progressed to an isthmic slip after the infant began ambulating. Following the development of
the Roentgenogram in 1895, population X-ray studies showed that isthmicspondylolisthesis is, in fact, quite
common. There have been reports that the defect is more common among athletes who participate in sports
with repeated hyperextension, such as gymnastics, ballet, and American football.[citation needed]
Spondylolysis also runs in families and is more prevalent in some populations, suggesting a hereditary
component, such as a tendency toward thin vertebral bone. For example, the frequency of spondylolisthesis
among the Inuit has been found to be 30–50 percent, as compared with an incidence in the general
population of 4–6 percent. It is theorized that the nomadic Inuit have a higher incidence of spondylolysis
due to trauma acquired as infants by being carried in an amauti. While in an amauti, the baby is put into
compressive extension with each step taken by the mother. [6]
Pain. The cause of pain in patients with isthmicspondylolisthesis remains unclear [citation needed]. The first
theory of pain production was segmental instability with excessive forward translation during flexion.
however, this has not been demonstrated radiographically.[citation needed] A more contemporary theory of pain
generation is excessive tension on the annulus of the inferior disc and foraminalstenosis at the level of the
slip.[citation needed] However, this theory has not explained the variance in symptoms experienced by patients.
Foraminalstenosis is also thought to play a role, but long-term studies on surgical outcome have shown that
many patients have poor results following decompression alone. Though, most likely pain in patients with
Spondylolisthesis is simply caused by the actual slippage of the disc in the spinal column.
Treatment
The appropriate treatment of patients with isthmicspondylolisthesis is controversial. [citation needed] For the
purposes of treatment and study, patients with isthmicspondylolisthesis are usually divided into two general
classes: low grade isthmicspondylolisthesis (<50 percent slip) and high grade isthmicspondylolisthesis (>50
percent slip).[5]
Conservative management
Patients with symptomatic isthmicspondylolisthesis are initially offered conservative treatment consisting
of activity modification, pharmacological intervention, and a physical therapy consultation.
physical therapy can evaluate and address postural and compensatory movement abnormalities
such as hyperlordosis and hip flexor and lumbar paraspinal tightness. Other modalities such as
thermal treatment, electrical stimulation and lumbar traction can help with reactive muscle spasm,
but should be coupled with therapeutic exercise.[citation needed]
Anti-inflammatory medications (NSAIDS) in combination with acetaminophen (Tylenol) can be
tried initially. If severe radicular component is present, a short course of oral steroids such as
Prednisone or Methylprednisolone can be considered. Epidural steroid injections, either
interlaminarl or transforaminal, performed under fluoroscopic guidance can help with severe
radicular (leg) pain. Lumbosacralorthoses may be of benefit for some patients but should be used
on a temporary basis to prevent spinal muscle atrophy and loss of proprioception.
Surgical
Degenerative spondylolisthesis with spinal stenosis is one of the most common indications for spine
surgery among older adults, and current evidence suggests that patients have much better success rates and
more clinical benefit with decompression and fusion than with decompression alone.[citation needed]
Low-grade isthmicspondylolisthesis
Surgical treatment is only considered after at least 6 weeks and often only after 6–12 months of nonoperative therapy has failed to relieve symptoms.[citation needed] Modalities of surgical treatment include:
Posterolateral fusion.
7. Posterolateral fusion in adult lumbar isthmicspondylolisthesis results in a significant improvement in 2-year
outcomes, but the difference between surgical and nonsurgical treatment narrows with time. [7] There has
been one randomized controlled trial for low-grade isthmicspondylolisthesis that compared non-operative
therapy to surgery.[8][9][10] The study evaluated the severity of pain and limitations of daily function in
patients with 'lumbar isthmicspondylolisthesis of any grade, at least 1 year of low back pain or sciatica, and
a severely restricted functional ability in individuals 18 to 55 years of age'. At two years follow-up, patients
who underwent surgery had significantly better scores for both pain and daily function. [8][9] The benefits
were reduced after nine years.[10] Nevertheless, posterolateral fusion for isthmicspondylolisthesis has been
one of the least controversial surgeries for spinal pathology and has consistently demonstrated good
outcomes[citation needed].
The success of stand-alone posterolateral fusion for treating adolescent isthmicspondylolisthesis led several
authors, including Dr Leon Wiltse and Dr Eugene Carriagee, to speculate about the effectiveness of
posterolateral fusion without a decompression for adult patients with both back and leg pain. In 1989, Drs.
Peek and Wiltse, et al. reported on eight cases of adults with high-grade spondylolisthesis who presented
with back pain and severe radicular pain.[11] These patients were all treated with an in situ
uninstrumentedposterolateral fusion and followed for an average of 5.5 years. At final follow-up, all eight
patients reported complete relief of their back pain and leg pain, no patients were taking analgesics for back
pain, and all patients were unrestricted with respect to work and recreational activities. The mean time to
complete resolution of symptoms was 2.8 months and all patients achieved a solid fusion. No patients
underwent subsequent surgery for either back pain or leg pain throughout the follow-up period. This was
the first report of excellent relief of leg pain in cases of isthmicspondylolisthesis from posterolateral fusion
without decompression.
Fusion with decompression
The addition of decompression does not appear to improve clinical outcome in addition to fusion for the
treatment of low-grade isthmicspondylolisthesis in patients without serious neurological deficit. A
randomized controlled trial compared fusion with a decompression to fusion without a decompression in
adult cases of isthmicspondylolisthesis . The study enrolled 42 patients and showed no benefit to
performing a decompression for isthmicspondylolisthesis; in fact, patients undergoing decompression had
worse clinical outcomes and a higher rate of pseudoarthrosis. [12]
High-grade isthmicspondylolisthesis
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(December 2008)
There are several forms of surgery that have been advocated for the treatment of high-grade
isthmicspondylolisthesis, including posterior interlaminar fusion, in situ posterolateral fusion, in situ
anterior fusion (ALIF), in situ circumferential fusion, instrumented posterolateral fusion, and surgical
reduction with instrumented posterior lumbar interbody fusion (iPLIF). Advocates of these different
techniques all cite specific advantages of each approach, but they all have established risks and some are
much more complication-prone than others.[citation needed]
The role of surgical reduction in the treatment of high-grade isthmic is a controversial topic.[citation needed]
Advocates of surgical reduction state that fusion in situ leaves too much residual deformity and impairs the
natural mechanics of the lumbar spine. Patients with high-grade isthmic tend to have hyper-lordosis of the
lumbar spine that compensates for the lumbosacralkyphosis associated with the severe slip and many feel
that this hyper-lordosis will lead to early arthritis and low back pain. Seitsalo, et al. reported on the largest,
long-term cohort of adolescents operated on for high-grade isthmicspondylolisthesis with 87 patients and
mean follow-up of 14 years. Of the patients, 54 had posterior interlaminar fusions, 30 had posterolateral
fusion, and 3 had an anterior interbody fusion (ALIF). The authors found a significant progression of
lumbosacralkyphosis in many of their patients. They also noted that patients undergoing single-level
fusions had much worse outcomes (p<0.0001) and they recommend fusing patients to L4 in virtually all
cases. The authors also concluded that the clinical outcome, while much better than prior to surgery, still
8. left several patients with significant symptoms and progression of deformity. The authors felt that reduction
may offer patients a better chance of excellent long-term outcomes.[citation needed]
Reduction became feasible with the development of pedicle screws, allowing the reduction to be
maintained. Several authors have published the results of reduction with pedicle screws and posterior
interbody fusion with posterolateral fusion. While the improvement in percent slipped and
lumbosacralkyphosis is significant, many have noted a 10–20 percent rate of nerve root injury and a few
cases reports of complete caudaequina, especially with complete reduction of the deformity. While many of
these injuries improve, several patients are left with permanent deficits. The clinical outcomes after
reduction and instrumentation do not appear to be significantly superior to fusion in situ using modern
techniques, despite the higher complication rate. It should also be noted that recurrence of deformity is
common after reduction and many patients will either bend their hardware or bend at the sacrum, which is
often fully segmented during adolescence. These facts have tarnished the notion of reduction and
instrumentation for high-grade slips, but the technique is still utilized with theoretical benefits and some
authors, particularly Dr Harry Shufflebarger, has reported both low complication rates and good clinical
outcomes. Dr. Shufflebarger currently performs reductions for all high-grade slips that are referred to him
and is a leading advocate of the technique. It should also be noted that the use of pedicle screw fixation is
much more extensive in the US than other countries and that these surgeons are somewhat more inclined to
reduce patients, at least partially, while instrumenting. The routine use of pedicle screws for one or two
level pediatric fusions (not long fusions for correcting scoliosis) is without proven benefit in clinical
outcome or fusion rate, but is associated with more blood loss, increased rate of nerve root injury, and more
cases of reoperation.[citation needed]
Until very recently,[when?] there was no data comparing the long-term outcome of reduction with
instrumented fusion to an uninstrumented in situ fusion. Poussa, et al. recently [when?] published the first
long-term follow-up report comparing reduction with instrumented posterolateral fusion to uninstrumented
circumferential fusion in situ with a mean follow-up of 14.8 years, and concluded that reduction and
instrumented fusion resulted in poorer long-term outcome than fusion in situ and that the deformity tended
to recur following reduction. The increased risks and more extensive surgery associated with reduction did
not translate into better outcomes or permanent correction of deformity. [citation needed]
In addition to the ongoing debate of reduction versus fusion in situ, there is also new evidence emerging as
to what form of fusion is most effect for eliminating symptoms and controlling deformity. This discussion
of surgical technique has been much enhanced recently by the publication of a long-term follow-up study
comparing three different techniques of fusion in situ for treating high-grade spondylolisthesis. The study
by Helenius, et al. compared the outcomes for posterolateral fusion, anterior interbody fusion (ALIF), and
circumferential fusion that is a combination of posterolateral and anterior fusion.[citation needed] Anterior fusion
is a relatively new technique to spine surgery, emerging during the last two decades. It involves either a
retroperitoneal or transperitoneal (through the abdomen) approach to the lumbosacral junction with
mobilization of the iliac arteries and veins. The surgeon then performs a total discectomy and places a bone
graft into the intervertebral space; the graft is usually either a tricortical iliac crest or a femoral ring
allograft. For circumferential fusion, after completing the anterior fusion, the patient is turned and a one or
two level posterolateral fusion without instrumentation is performed. Circumferential fusion can either be
performed under one run of general anesthesia with patient repositioning or the procedure can be staged.
Helenius, et al. followed 70 patients for a mean period of 17 years who had been treated by one of the
above procedures and concluded that circumferential fusion provided the best long-term outcomes among
the three techniques with excellent long-term outcomes and a low complication rate.[citation needed]
Prognosis
The majority of low-grade slips are asymptomatic and do not progress past a patient’s initial presentation.
Prospective studies on children with low-grade slips have demonstrated that once a slip occurs, it rarely
worsens, even after 40+ years of follow-up. However, high-grade slips do continue to progress in many
cases and are much more likely to cause pain. One natural history study by a Swedish researcher, Saraste,
found that roughly 60 percent of patients with slips greater than 15 mm (which is roughly a Meyerding
9. grade 2 or greater) had persistent daily symptoms, including both back pain and radiculopathy. The lowgrade slips in Saraste's study were symptomatic in only 10 percent of patients. [citation needed]
Some cases do eventually progress to complete spondyloptosis and prevention of progression is the primary
focus of surgery for high-grade slips. Why low-grade slips tend not to progress and why certain slips
ultimately become severe is not known. There have been few long-term follow-up studies on patients with
high-grade spondylolisthesis who did not undergo surgery. Harris and Weinstein reported on eleven
patients after a mean follow-up of 18 years, all of which had greater than 50 percent slip and did not have
surgery. Thirty-six percent of patients were asymptomatic, 55 percent of patients had relatively mild
symptoms, and only one (9 percent) was disabled. The patients with mild symptoms were all able to work
and participate in recreational activities, although they did need to make modifications to their lifestyle. No
patient developed fulminantcaudaequina syndrome, severe neurologic symptoms, or incontinence. Fortyfive percent of patients had some neurologic abnormalities on exam, including weakness, paresthesias, and
diminished deep tendon reflexes. Patient symptoms were primarily related to mild to moderate neurologic
symptoms, muscle weakness, especially abdominal muscles, inactivity/deconditioning, obesity, lack of
spinal mobility, and the late development of degenerative scoliosis with lateral listhesis (a deformity
associated with advanced osteoarthritis of the lumbar spine). The patients in this study were a group of 21
patients who had undergone classic posterior interlaminar fusion from L4 to S1 for their severe slip with.
The surgically treated patients were less symptomatic with 57 percent reporting no symptoms and no
limitations, 36 percent reporting mild symptoms, and 5 percent reporting severe symptoms12. It should also
be noted that the outcomes of posterior interlaminar fusions were poorer than newer posterolateral and
circumferential techniques now utilized. Patients with posterior-only fusions tend to have more progression
of their spondylolisthesis following surgery and more pain as well. [citation needed]
History
It was first described in 1782 by Belgianobstetrician, Dr. Herbinaux.[13] He reported a bony prominence
anterior to the sacrum that obstructed the vagina of a small number of patients.[14] The term
“spondylolisthesis” was coined in 1854 from the Greekσπονδυλος = "vertebra" and "ὁ λισθος" =
"slipperiness," "a slip."[15]
See also
Spondylosis
Failed back syndrome
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