Spondylolisthesis with gross osteoporosis

772 views

Published on

Published in: Health & Medicine
  • Be the first to comment

Spondylolisthesis with gross osteoporosis

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

×