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Spondylolisthesis
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- 2. Spondylolisthesis o Spondylolisthesis isthe forward displacement of a vertebra, especially the fifth lumbar vertebra. Do not get confuse with- o Spondylosis- is degenerative osteoarthritis of the joints between the center of the spinal vertebrae or neural foramina. o Spondylitis- is an inflammation of the vertebra. o Spondylolysis- is a defect of a vertebra. More specifically it is defined as a defect in the pars interarticularis of the vertebral arch.
- 3. Spondylolisthesis • It isthe forward displacement of the vertebrae, especially the fifth lumber vertebrae. • Most commonly occur after fracture. • Backward displacement is known as Retrolisthesis.
- 4. Causes • Most commonlyoccur after fracture. • May occur due to- – Birth defect in that area of the spine – Sudden injury (acute trauma). • In adult most common cause is- – Abnormal wear on the cartilage and bones, such as arthritis.
- 5. Classification • Types ofspondylolisthesis- – Isthmic • there is a defect in a portion of the vertebra called the pars interarticularis. • Isthmic spondylolisthesis can be caused by-repetitive trauma and is more common in athletes exposed to hyperextension motions, including gymnasts and football linemen. – Degenerative • Degenerative spondylolisthesis occurs due to arthritic changes in the joints of the vertebrae due to cartilage degeneration. • Degenerative spondylolisthesis is more common in older patients. – Pathologic • Pathologic spondylolisthesis is caused by a defect in the bone caused by abnormal bone, such as from a tumor. – Traumatic • Traumatic spondylolisthesis is due to direct trauma or injury to the vertebrae. • This can be caused by a fracture of the pedicle, lamina, or facet joints that allows the front portion of the vertebra to slip forward with respect to the back portion of the vertebra. – Pathologic • Pathologic spondylolisthesis is caused by a defect in the bone caused by abnormal bone, such as from a tumor. – Dysplastic • Dysplastic spondylolisthesis is caused by a defect in the formation of part of the vertebra called the facet that allows it to slip forward. • This is a condition that a patient is born with (congenital).
- 6. Clinical Feature • Symptoms 1)Lower back pain. 2) Muscle tightness (tight hamstring muscle). 3) Pain, numbness, or tingling in the thighs and buttocks. 4) Stiffness. 5) Weakness in the legs. 6) Loss of bladder or bowel control, in rare cases. • Sign 1) Tenderness in the area of the vertebra that is out of place. 2) Leaning-forward or semi- kyphotic posture. 3) Waddle. 4) A noticeable atrophy in the gluteal muscles due to lack of use.
- 7. Diagnosis • X-rays • CTscan • MRI (to pin pint damage and guide treatment.)
- 8. Grading of spondylolisthesis •Spondylolisthesis is graded according the percentage of slip of the vertebra compared to the neighboring vertebra- 1) Grade I is a slip of up to 25%. 2) Grade II is between 26%-50%. 3) Grade III is between 51%-75%. 4) Grade IV is between 76%-100%. 5) Grade V, or spondyloptosis, occurs when the vertebra has completely fallen off the next vertebra.
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- 10. Treatment • Treatment methods- –Conservative • Stop any physical activity that may lead to vertebral damage. • Physical therapy can evaluate and address postural and compensatory movement abnormalities. • Anti-inflammatory medications (NSAIDS) in combination with acetaminophen to relieve pain. – Surgical • Degenerative spondylolisthesis with spinal stenosis is one of the most common indications for spine surgery among older adults.
- 11. Complication • If toomuch movement occurs, the bones may begin to press on nerves. • Temporary or permanent damage of spinal nerve roots, which may cause sensation changes, weakness, or paralysis of the legs. • Chronic back pain. • Infection.