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This includes, but is not limited to: dependence on medications or other treatments requiring frequent clinical monitoring, special handling or severe dietary restrictions.

Repetitive trauma in clinical onset or aggravation of Spondylolisthesis and/or Spondylolysis

PT is a positional parameter defined as the angle between the line connecting the midpoint of the superior sacral end plate to the femoral rotational axis and the line extending vertically from the femoral rotational axis. It denotes the spatial orientation of the pelvis, which varies according to position, with a greater or lesser degree of tilt forwards (pelvic anteversion) or backwards (pelvic retroversion) in relation to a transverse axis passing through the two femoral heads. The greater the angle of pelvic tilt, the further the center of gravity is projected behind the femoral heads[23,24].


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Sagittal imbalance of the spine is mainly related to any underlying pathology causing loss of lumbar lordosis (LL) such as multilevel degenerative disk disease, ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis, osteoporosis, tumor, trauma, or infection (Figure 3)[13]. Secondary causes include iatrogenic flat back syndrome being attributed to the use in the past of distraction instrumentations such as the Harrington rods[14,15]. Nowadays iatrogenic flat back syndrome is more frequent due to lack of recreating the appropriate LL accordingly to the patient’s PI. In other cases loss of LL appears following spinal fusion surgery through an area of pseudarthrosis or through a degenerated segment adjacent to a previous fusion.


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Posterior spinal fusion means a surgical procedure involving immobilization of the posterior elements of two or more vertebrae by the use of bone grafting, in the absence of immobilization of the lateral elements, of the same vertebrae. This type of surgery produces an abnormality in the functional loading of the adjacent vertebrae, and can result in either Spondylolysis or Spondylolisthesis.

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Spinal stenosis is a condition in which your spinal canal narrows. May cause back pain and other nerve related problems. Th proper exercise and treatment, you. Picture Of Lumbar Retrolisthesis

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Posterior spinal decompression surgery, at the level of the involved vertebra, prior to clinical onset or aggravation of Spondylolysis or Spondylolisthesis

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The PI is a non-positional anatomical parameter defined as the angle between the line perpendicular to the sacral plate at its midpoint and the line connecting this point to the axis of rotation of the femoral head[20]. The PI angle determines the relative position of the sacral plate in relation to the femoral heads and determines the remaining variable parameters being equal to the sum of SS+PT[19, 20].

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Severe trauma to the thoracic spine means a major, high impact, direct injury to the thoracic spine which produces immediate thoracic spine pain and precludes unaided ambulation for a period of at least 2 weeks, and is associated with other fractures and/or significant soft tissue injuries. Examples are as follows: