You could have picked it up as a child and it may have gone undetected, but in your adulthood with increased physical activity, along with the wear and tear of life, it may manifest and you would be in enough pain to visit a doctor who would confirm LS. This type of Lumbosacral Spondylolisthesis is referred to as Developmental Lumbosacral Spondylolisthesis – that which may have existed at birth or may develop during childhood, but is generally not noticed until much later. The other type is Acquired Spondylolisthesis, by daily stress that you put on the spine, such as carrying heavy weights and physical sports which cause the spine to weaken. Alternatively, a single or repeated force being applied to the spine can also cause LS.
Grade 1 spondylolisthesis can happen as the result of injury at any age, but it usually arises gradually in older adults. As the spinal discs undergo wear and tear, they may become dried out and compressed. This compression of the spine can cause the vertebrae to overlap one another, while the disc itself may protrude into the spinal canal, pinching nerves.
Spondylolisthesis, Spondylolysis - Radsource
Debilitating pain - spondylysis - spondylolithesis 1. Pars fusion - painful spondylysis - minimal spondylolithesis 2. Fusion A. In situ v reduction - not required for grade 1 - 2 - consider if sagittal malalignment - associated with risk neurology especially L5 - controversial if should be performed in high grade slips B. Instrumented / non instrumented C. Levels - L5/S1 if grade I or II / 50% or less - L4/S1 if 50% for more D. Interbody cages - useful in long standing spondylolithesis presenting in adulthood - degenerative disc disease - nerve root pain from interforaminal compression - improves nerve root space - improves healing rate E. Posterior v circumferential - circumferential approaches may improve fusion rates and outcome in high grade slips Indication - normal discs and facets - pain relieved by pars injection - failure brace / non operative treatment - minimal slip Technique - lesion identified / debrided / iliac crest bone graft Options ORIF 1. Screw across lytic defect - unilateral defect 2. Pedicle screw + laminar hook - bilateral defect 3. TBW spinous process and transverse process Results Kakluchi et al JBJS Am 1997 - 16 patients with failure non operative treatment bilateral pars defect - pain relieved by pars injection with LA - pedicle screw + lamina hook - nerve root decompression where required - union in all 16 - 3 patients only had occasional back pain A. Wiltse Lateral Mass Fusion in situ Concept - in situ fusion via a paraspinal muscle splitting approach - no reduction or instrumentation Indication - for L5/S1 with minor slip in young patient - rarely done these days - most surgeons perform instrumented fusion Technique - midline incision - two paramedian incisions in lumbodorsal fascia 4.5cm lateral to midline - paraspinous muscle splitting approach 2 fingerbreadths lateral to midline - split sacrospinalis using finger to dissect through muscle - don't go anterior to TP or risk damage to nerve root - decorticate TP / Sacral ala / facet / famina and add crest graft / allograft / BMP Post-op - spica 3/12 with 1 leg incorporated - activity modification for 6/12 Instrumented fusion in situ without reduction Indications - slip grade 1 or II - grade III or IV with no sagittal malalignment Levels instrumentation - L5 / S1 grade I or II - L4 / S1 grade III or IV Options 1. Pedicle screw instrumentation 2. PLIF / interbody cage 3. Bohlman procedure - interbody fusion with fibula strut - augmented with decompression and PLF 4.
5 Best Homeopathic Medicines for Cervical Spondylosis
As in our patient, spondylolysis may lead to spondylolisthesis, a forward (ventral) subluxation of an upper vertebra on a lower vertebra. Wiltse and coworkers have classified spondylolisthesis into five types based upon etiology:12
Thecal Sac Impingement - The Ultimate Chiropractic …
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.
This page contains Chapter 5 of the text Motion Palpation by R
Imaging evaluation of a patient with low back pain typically begins with a series of lumbar spine radiographs. Spondylolysis is usually evident on lateral radiographs, although oblique projections may be useful. On frontal projections, fragmentation of the lamina may be identified.4 If spondylolisthesis is present, it should be graded according to the Myerding system,5 with grade I indicating anterior subluxation of less than 25%; grade II, 25% to 50%; grade III, 50% to 75%; and grade IV, 75% to 100%.
Spinal Surgery: Laminectomy and Fusion - Medical …
(5a) A 3D illustration of the lumbosacral region demonstrates the typical location of the osseous defect in patients with spondylolysis. Illustration courtesy of Michael E. Stadnick, M.D.