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2018 ICD-10-CM Index > 'Spondylolisthesis'
For most cases of degenerative spondylolisthesis (especially Grades I and II), treatment consists of temporary bed rest, restriction of the activities that caused the onset of symptoms, pain/ anti-inflammatory medications, steroid-anesthetic injections, physical therapy and/or spinal bracing.
Most people will experience some degenerative changes in their spines as they age. However, severe spondylolisthesis only affects a small percentage of the population. Overall, most degenerative disorders of the spine can be treated successfully using non-surgical methods. We can work closely with you to find a treatment method that is best for you and help you return to an active, and pain-free, lifestyle.
Spondylolisthesis Overview | Grades, Causes, and Treatm…
Isthmic spondylolisthesis, the most common form of this condition, is caused by a bony defect (or fracture) in an area of the pars interarticularis, an area located in the roof (laminae) of the vertebral structure. This bony defect occurs in approximately 4% of the population, and results from a genetic failure of bone formation. The condition most commonly affects the fourth and fifth lumbar vertebrae (L4 and L5) and the first sacral vertebra (S1). It is interesting to note that the condition is not always painful.
For most cases of isthmic spondylolisthesis (especially Grades I and II), treatment consists of temporary bed rest, restriction of the activities that caused the onset of symptoms, pain/ anti-inflammatory medications, steroid-anesthetic injections, physical therapy and/or spinal bracing.
Surgery is rarely needed unless the case is severe (usually Grade III or above), neurological damage has occurred, the pain is disabling, or all non-operative treatment options have failed.
How can the answer be improved?
The displacement of one vertebra in relation to the adjacent vertebra,usually of the fifth lumbar over the body of the sacrum, or the fourth lumbarover the fifth lumbar vertebra. Degenerative spondylolisthesis is caused by long-standing instabilitydue to progressive degeneration of the spinal joints. It is usually accompanied by the rotation ofthe affected disk. The correct ICD-9code for degenerative or acquired spondylolisthesis is 738.4. It may be congenital disorder; however, thiscondition is extremely rare. It must beclearly stated in the medical record that the condition is congenital (ICD-9code 756.12); otherwise, the condition is presumed to be acquired.
For most cases of degenerative spondylolisthesis, treatment consists of temporary bed rest, restriction of the activities that caused the onset of symptoms, pain/ anti-inflammatory medications, steroid-anesthetic injections, physical therapy and/or spinal bracing.
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Spondylolisthesis Treatment, Surgery & Symptoms
Lytic spondylolisthesis usually occurs at L5/S1 and normally presents in the teenage years or 20s. The classical example is the so-called fast (cricket) bowler’s “stress fracture”. It occurs due to repetitive stresses in the lumbar spine but it often appears with no obvious history of repetitive trauma.
Learn about the types and symptoms of spondylolisthesis
It is thought that athletic activities that require repeated hyperextension and rotation or repetitive combined flexion-extension predisposes athletes to develop pars defects. There are multiple types of spondylolisthesis and the exact cause is unknown.Isthmic and degenerative are the two types that are most common in adults. The three other types include traumatic, pathological, and dysplastic. The case study patient was a Lytic spondylolisthesis, which is always due to a fatigue fracture and is commonly seen in patients less than 50 years old.Overall, as the vertebral body slips forward there is narrowing of the spinal canal and intervertebral foramen which results in stenosis. As stenosis occurs the typical presentation changes from one of back pain to one that includes radicular symptoms. The typical clinical presentation of a spondylolisthesis is pain generally localized in the lumbar paraspinals, gluteals, and posterior aspects of the thighs. The symptoms usually increase with standing or walking. As the slippage progresses there is typically more irritation of the nerve root and the hamstrings become tight. This may be of benefit to a patient because of the hamstring insertion into the ischial tuberosities which would support a posterior pelvic tilt and subsequently decrease lumbar lordosis. Patients tend to walk in a more flexed position and develop increased hip flexor muscle tension. Flattening of the sacrum can be seen as the patient attempts to stop the slippage.Diagnosis usually occurs by radiographs and the slip can be graded by the Meyerding’s system. In this system a Grade I is up to 25% displacement, Grade II 50%, Grade III 75%, Grade IV 100%, and Grade V greater than 100% displacement.It has been found that only 10-15% of these patients go on to have spinal surgery and that most improve with nonoperative treatment. Typical nonoperative care includes rest, NSAIDS, ESIs, and a physical therapy program. Clinical significant improvements have been found with interventions that included lumbar flexion exercises and walking, but even more substantial improvement was found with the addition of manual therapy (joint mobilization and manual stretching) when performed to the lumbar spine and lower extremities.
The most common symptom of spondylolisthesis is lower back pain
Spinal stenosis is due to congenitally short pedicles, or it may be acquired as a result of combinedfacet hypertrophy, degenerated bulging disk, and hypertrophy of the ligamentum flavum. Congenitalspinal stenosis can be idiopathic or associated with a developmental disorder, such as achondroplasia,hypochondroplasia, Morquio's mucopoly-saccharidosis, and Down's syndrome. Spondylolisthesis,trauma, and surgical fusion are other causes of spinal stenosis.
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