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1: Oblique x-ray view of the lumbar spine ("Scotty Dog" view).
Some surgeons attempt to reduce the spondylolisthesis in order improve the overall sagittal alignment and spinal biomechanics. This has the benefit of improving standing posture and placing less strain on the posterior fusion mass and spinal hardware reducing the incidence of nonunion and spondylolisthesis progression. The quoted rate of transient or permanent nerve-root injury associated with reduction is 5-30%.
Bone scanning can be very useful in demonstrating acute fracture of the pars interarticularis in persons with isthmic-type spondylolisthesis. It is also used in degenerative-type slips to reveal any acute reaction, though it has low specificity in this application.
spondylolisthesis: when one vertebra slips forward on another.
Magnetic resonance imaging (MRI) is most sensitive in demonstrating soft tissues and ascertaining the presence of central and foraminal stenosis. It also can demonstrate endplate reactive changes (Modic types I and II) observed in individuals with degenerative spondylolistheses. Use of MRI in isthmic and dysplastic types is limited.
If slippage continues or if your pain doesn’t respond to conservative treatment, surgery may be necessary. Surgery can address both the instability of the spine and compression of the nerve roots. The surgeon may first perform a lumbar laminectomy to relieve pressure on the nerve root. Then a bone graft will be used to fuse the loose vertebrae and keep them from sliding out of place. In some cases metal plates, hooks, rods and screws may be used to support the fusion (Fig. 5). It may take a while for the two pieces of bone to grow together, so you should avoid extremes of motion while healing.
We treat more than 600 patients with spondylolisthesis each year.
Although computed tomography (CT) is poor for demonstrating spondylolisthesis, it is useful in demonstrating pars interarticularis (isthmus) defects, facet arthropathy, canal diameter, foraminal stenosis, and disc herniation. When combined with myelography (static or dynamic flexion and extension views), CT may demonstrate evidence of nerve-root compression and concomitant instability. Myelography is generally not indicated unless neurologic signs or pain unexplained by findings other imaging methods exists.
Before surgery is considered for adult patients presenting with degenerative spondylolisthesis, minimal neurologic signs, or mechanical back pain alone, conservative measures should be exhausted, and a thorough evaluation of social and psychological factors should be undertaken.
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Spondylolysis and Spondylolisthesis of the Lumbar …
In more severe cases, a gap may be seen, or be palpable, at the level of the spondylolisthesis, and may be increased when the patient is moved into extension.
Spondylolysis and spondylolisthesis - Mayfield Clinic
On the other hand, should the spondylolisthesis be at fault, the aims of treatment would be to decrease symptoms, stabilise the spine and control the degree of lordosis.
Adult Isthmic Spondylolisthesis - Spine - Orthobullets
Using correct posture (see ) and keeping your spine in alignment are the most important things you can do for your back. The lower back (lumbar curve) bears most of your weight, so proper alignment of this section can prevent further slippage and injury to your spinal nerves and discs. You may need to make adjustments to your daily standing, sitting, and sleeping habits. You may also need to learn proper ways to lift and bend (see ). You may need to wear a back brace for a short period of time while you strengthen the abdominal and lower back muscles. The brace may decrease muscle spasm and pain as well as help immobilize your spine and help the healing process. Your doctor may refer you to an orthotist who specializes in custom-made braces.
Spondylolysis & Spondylolisthesis - USC Spine Center
Correction of the listhesis is associated with risk of neurologic injury, both transient and permanent. Some surgeons prefer to fuse the spine in place rather than to reduce the subluxation. In persons with higher-grade spondylolisthesis, use of interbody grafts is associated with a high rate of complications. However, the use of these devices adds to the stability of the spinal segment, helps with the reduction of the deformity, and helps achieve sagittal balance, thus ensuring better outcome.
Degenerative Spondylolisthesis - Spine - Orthobullets
The patient with degenerative spondylolisthesis is typically older and presents with back pain, radiculopathy, neurogenic claudication, or a combination of these symptoms. The slip is most common at L4-5 and less common at L3-4. The radicular symptoms often result from lateral recess stenosis from facet and ligamentous hypertrophy, disk herniation, or both. The L5 nerve root is affected most commonly and causes weakness of the extensor hallucis longus. Concomitant central stenosis and neurogenic claudication may or may not exist.
Explaining Spinal Disorders: Degenerative Spondylolisthesis
In other instances, a person with spondylolysis may develop a spondylolisthesis with trauma, or a person with a spondylolisthesis may have an increased slip, as a result of the trauma.
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