Spondylolisthesis: Difference between revisions
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== Management / Interventions<br> == | == Management / Interventions<br> == | ||
<u>General<br></u>• Initially resting and avoiding movements like lifting, bending and sports.<br>• Anti-inflammatory medicine to improve the infection and diminish the pain<ref name="M.W van Tulder">M.W van Tulder et al. Nonsteroidal anti-inflammatory drugs for low back pain: a systematic review within the framework of the Cochrane collaboration back review group. Spine 2000 25:2501–2513.</ref> .<br>• A corticosteroid injection can be used if patients have pain in the leg or numbness<br>• Sometimes a hyperextension brace can be used. This is useful because during the hyperextension of the lumbar spine the verterbrae get closer together.<br>• When the condition is very severe a surgical intervention may be necessary to attach the vertebras together.<br>• A surgical intervention has better results than a nonsurgical care in case of neurological symptoms<ref name="J.N. Weinstein">J.N. Weinstein et al. Surgical versus non-surgical treatment for lumbar degenerative spondylolisthesis. N. Engl. J. Med 2007 May 31;356 (22): 2557-2270.</ref>. | <u>General<br></u>• Initially resting and avoiding movements like lifting, bending and sports.<br>• Anti-inflammatory medicine to improve the infection and diminish the pain<ref name="M.W van Tulder">M.W van Tulder et al. Nonsteroidal anti-inflammatory drugs for low back pain: a systematic review within the framework of the Cochrane collaboration back review group. Spine 2000 25:2501–2513. (1A)</ref> .<br>• A corticosteroid injection can be used if patients have pain in the leg or numbness<br>• Sometimes a hyperextension brace can be used. This is useful because during the hyperextension of the lumbar spine the verterbrae get closer together.<br>• When the condition is very severe a surgical intervention may be necessary to attach the vertebras together.<br>• A surgical intervention has better results than a nonsurgical care in case of neurological symptoms<ref name="J.N. Weinstein">J.N. Weinstein et al. Surgical versus non-surgical treatment for lumbar degenerative spondylolisthesis. N. Engl. J. Med 2007 May 31;356 (22): 2557-2270. (1B)</ref>. | ||
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<u>Physical therapy<br></u>The initial therapy for spondylolisthesis is a conservative treatment done by the physiotherapist. Physical therapy is used to improve the range of motion of the lumbar spine and the hamstrings. Also improving the strength of the abdominal muscles is a very important part of the therapy, so that the spine can be stabilized. | <u>Physical therapy<br></u>The initial therapy for spondylolisthesis is a conservative treatment done by the physiotherapist. Physical therapy is used to improve the range of motion of the lumbar spine and the hamstrings. Also improving the strength of the abdominal muscles is a very important part of the therapy, so that the spine can be stabilized. | ||
The physiotherapist needs to give the patient information about the posture, lifting techniques and the use of heat to diminish the symptoms.<br>A brace can be used to reduce the pain, but it does not reduce the shift of the vertebra<ref name="L. Kalichman">L. Kalichman et al. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J (2008) 17;327 – 335.</ref>. So it is a good aid during the painful periods but it is not to be used when the patients complaints are reduced. <br> | The physiotherapist needs to give the patient information about the posture, lifting techniques and the use of heat to diminish the symptoms.<br>A brace can be used to reduce the pain, but it does not reduce the shift of the vertebra<ref name="L. Kalichman">L. Kalichman et al. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J (2008) 17;327 – 335. (2B)</ref>. So it is a good aid during the painful periods but it is not to be used when the patients complaints are reduced. <br> | ||
Strengthening the deep abdominal muscles is a very important part of the physical therapy. Isometric and isotonic exercises for the main muscle groups of the trunk provide a stabilization of the spine and a reduction of the pain<ref name="M. Sinaki">M. Sinaki et al. Lumbar spondylolisthesis: retrospective comparison and three year follow-up of two conservative treatment programs. Arch Phys Med Rehabil 1989 70:594-598.</ref>. Also the hamstrings need to be stretched, so that their mobility can be improved. <br>An excellent exercise is stationary bicycling because it promotes the spine flexion. Impact sports like running should not be done because it provokes wear. Other sports that can be practiced are walking and swimming. They have no value in improving the shift, but these sports are good alternatives for cardiovascular exercises<ref name="L. Kalichman" />. <br> | Strengthening the deep abdominal muscles is a very important part of the physical therapy. Isometric and isotonic exercises for the main muscle groups of the trunk provide a stabilization of the spine and a reduction of the pain<ref name="M. Sinaki">M. Sinaki et al. Lumbar spondylolisthesis: retrospective comparison and three year follow-up of two conservative treatment programs. Arch Phys Med Rehabil 1989 70:594-598. (1B)</ref>. Also the hamstrings need to be stretched, so that their mobility can be improved. <br>An excellent exercise is stationary bicycling because it promotes the spine flexion. Impact sports like running should not be done because it provokes wear. Other sports that can be practiced are walking and swimming. They have no value in improving the shift, but these sports are good alternatives for cardiovascular exercises<ref name="L. Kalichman" />. <br> | ||
== Differential Diagnosis<br> == | == Differential Diagnosis<br> == | ||
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Search strategy[edit | edit source]
I started by searching some general information about spondylolisthesis. After that I searched for evidence based information by using scientific articles.
Definition / Description[edit | edit source]
Spondylolisthesis is a deviation of the spine when a shift of the vertebra occurs compared to the one just below. It is frequently situated at the fourth and fifth lumbar vertebra[1]. This shift is forward orientated, sometimes backwards, but this is rather uncommon.
A forward shift is called an anterolysthesis and a backward shift is called retrolysthesis. The degree of spondylolisthesis is generally mild, with a mean of 14%. Because of the shift it is possible that a nerve can be compressed or that the spinal canal is narrowed.
Symptoms that can occur with spondylolisthesis are low back pain, pain in the legs or a combination of both. Patients complain of deep, dull pain typically situated in the lumbosacral region after exercise, especially with an extension of the lumbar spine. The range of motion is diminished and the hamstrings are tense. When there is a compression of a nerve, patients mostly develop numbness, pain or tingling. If the compression is very severe it may be possible that the patient develops the cauda equine syndrome.
Clinically Relevant Anatomy
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Mechanism of Injury / Pathological Process
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Clinical Presentation[edit | edit source]
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Diagnostic Procedures[edit | edit source]
Spondylolisthesis is featured by the following characteristics. It is mostly clear that the patient has complaints of pain in the lower back and leg. In the history the majority of the people have had a fall or trauma. During the inspection and physical examination of the patient there are typically no visible signs of spondylolisthesis but there may be a tightness of the hamstrings. The abdominal muscles are weakened and there can be an increase of the lumbar lordosis[2]. The patient has trouble with flexion and extension of the spine because it hurts.
When the physiotherapist is not sure, an axial loaded MRI can always identify the disorder[3].
The severity of spondylolisthesis is expressed in grades. According the degree of shift, there are five grades:
- Grade 1: <25%
- Grade 2: 25% - 50%
- Grade 3: 51% - 75%
- Grade 4: >75%
Outcome Measures[edit | edit source]
add links to outcome measures here (see Outcome Measures Database)
Management / Interventions
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General
• Initially resting and avoiding movements like lifting, bending and sports.
• Anti-inflammatory medicine to improve the infection and diminish the pain[4] .
• A corticosteroid injection can be used if patients have pain in the leg or numbness
• Sometimes a hyperextension brace can be used. This is useful because during the hyperextension of the lumbar spine the verterbrae get closer together.
• When the condition is very severe a surgical intervention may be necessary to attach the vertebras together.
• A surgical intervention has better results than a nonsurgical care in case of neurological symptoms[5].
Physical therapy
The initial therapy for spondylolisthesis is a conservative treatment done by the physiotherapist. Physical therapy is used to improve the range of motion of the lumbar spine and the hamstrings. Also improving the strength of the abdominal muscles is a very important part of the therapy, so that the spine can be stabilized.
The physiotherapist needs to give the patient information about the posture, lifting techniques and the use of heat to diminish the symptoms.
A brace can be used to reduce the pain, but it does not reduce the shift of the vertebra[6]. So it is a good aid during the painful periods but it is not to be used when the patients complaints are reduced.
Strengthening the deep abdominal muscles is a very important part of the physical therapy. Isometric and isotonic exercises for the main muscle groups of the trunk provide a stabilization of the spine and a reduction of the pain[7]. Also the hamstrings need to be stretched, so that their mobility can be improved.
An excellent exercise is stationary bicycling because it promotes the spine flexion. Impact sports like running should not be done because it provokes wear. Other sports that can be practiced are walking and swimming. They have no value in improving the shift, but these sports are good alternatives for cardiovascular exercises[6].
Differential Diagnosis
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Key Evidence[edit | edit source]
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Resources
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Case Studies[edit | edit source]
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References[edit | edit source]
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- ↑ N.J. Rosenberg. Degenerative spondylolisthesis. Predisposing factors. The journal of Bone and Joint Surgery (1975) 57:467-474. (1C)
- ↑ B. Kalpakcioglu, T. Altinbilek, K. Senel. Determination of spondylolisthesis in low back pain by clinical evaluation. Jounal of Back a Musculoskeletal Rehabilitation 22 (2009) 27-32. (2B)
- ↑ P. Jayakumar et al. Dynamic degenerative lumbar spondylolisthesis: diagnosis with axial loaded magnetic resonance imaging, Spine. (Phila Pa 1976) 2006 May 1;31 (10): E298-301. (2B)
- ↑ M.W van Tulder et al. Nonsteroidal anti-inflammatory drugs for low back pain: a systematic review within the framework of the Cochrane collaboration back review group. Spine 2000 25:2501–2513. (1A)
- ↑ J.N. Weinstein et al. Surgical versus non-surgical treatment for lumbar degenerative spondylolisthesis. N. Engl. J. Med 2007 May 31;356 (22): 2557-2270. (1B)
- ↑ 6.0 6.1 L. Kalichman et al. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J (2008) 17;327 – 335. (2B)
- ↑ M. Sinaki et al. Lumbar spondylolisthesis: retrospective comparison and three year follow-up of two conservative treatment programs. Arch Phys Med Rehabil 1989 70:594-598. (1B)
