spondylolisthesis. outcomes be familiar with the definition of spondylolisthesis. be familiar with...
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SPONDYLOLISTHESIS
Outcomes Be familiar with the definition of
Spondylolisthesis. Be familiar with the pathology of a typical
Spondylolisthesis. Be familiar with the types of Spondylolisthesis. Be familiar with the clinical presentation of a
typical patient with Spondylolisthesis. Be familiar with the most widely used
physiotherapy treatment protocols for a patient with
typical Spondylolisthesis. Be able to give appropriate advice to a patient with
typical Spondylolisthesis.
Definition Anterior displacement (antero-listhesis) of a
vertebral body upon the bottom vertebral
body Usually occurs between L4-L5 and between L5-S1 Generally occurs in families Posterior displacement: retro- listhesis
Spondylolisthesis
Pathology In the standing position there is a
constant downward and forward force on the lower lumbar vertebrae
Body mass and normal movement may give rise to spondylolisthesis
The anatomical structure of the lumbo-sacral area of the vertebral column is affected
Pathology The degree of antero displacement is
explained in Grades I to IV
These grades each comprise a quarter of the surface of the bottom vertebrae
Grade I and II is treated conservatively
Grade III and IV should undergo a fusion
Five types Congenital spondylolisthesis (L5/S1) –
more common in girls and sometimes associated with spina bifida.
Spondylolytic spondylolisthesis (L5) – due to bilateral spondylolisthesis
Traumatc spondylolisthesis – due to a fracture of the pars interarticulari e.g. Parachute jumping
Five types Degenerative spondylolisthesis (L4) –
uncommon before the age of 50
Pathological spondylolisthesis – after local or general bone diseases e.g. tumour or infections
X-rays
Signs and symptoms Back or leg pain Back feels weak Sometimes lumbar scoliosis and
increased kyphosis Step is felt in the back Unilateral and sometimes bilateral nerve
root compression with pain in the legs Segmental instability Stiff back extensors, hamstring and m
psoas – attempt to stabilise the pelvis
Signs and symptoms Extension is the most common restricted
range Pain increases during standing especially
in high heeled shoes, walking down hill, prone and other extension activities
Experiencing difficulty to come out of flexion, must press on thighs with hands
Extension is painful and restricted SLR is restricted Pain relief while sitting, supine and crook-
lying (stable positions)
Treatment Asymptomatic: No treatment
Symptomatic: Severe cases – bed rest static traction localised heat analgesics
Stable cases – relief of symptoms stabilisation improvement of posture advise
Relief of symptoms
Maitland mobilisations (no strong techniques as a result of the instability) Rotation up to Grade IV- Longitudinal in flexion Palpation techniques no further than Grade II (be extremely careful) Static traction (27,5 kg – 35 kg)
Relief of symptoms Trigger points Neural mobilisations Stretch of back extensors and m
psoas Strengthening of abdominal
stabilisers, m gluteus and m quadriceps
Re-education of correct posture
Advise Sitting is better than standing Avoid running, jumping, horseback
riding and other jerky movements Swimming and cycling are good
exercises Avoid contact sport
Advise
Avoid becoming overweight Wear a corset with painful activities Housewife must use trolley during
shopping Retain abdominal stabilisation at all
times Comfortable position is usually with
pillow underneath the legs