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SPONDYLOLISTHESIS

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

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SPONDYLOLISTHESIS

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  1. SPONDYLOLISTHESIS

  2. 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.

  3. 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

  4. Spondylolisthesis

  5. 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

  6. 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

  7. Five types • Congenital spondylolisthesis (L5/S1) – more common in girls and sometimes associated with spina bifida. • Spondylolyticspondylolisthesis (L5) – due to bilateral spondylolisthesis • Traumatcspondylolisthesis – due to a fracture of the pars interarticulari e.g. Parachute jumping

  8. Five types • Degenerative spondylolisthesis (L4) – uncommon before the age of 50 • Pathological spondylolisthesis – after local or general bone diseases e.g. tumour or infections

  9. X-rays

  10. 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

  11. 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)

  12. Treatment • Asymptomatic: No treatment • Symptomatic: Severe cases – bed rest static traction localised heat analgesics Stable cases – relief of symptoms stabilisation improvement of posture advise

  13. 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)

  14. 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

  15. Advise • Sitting is better than standing • Avoid running, jumping, horseback riding and other jerky movements • Swimming and cycling are good exercises • Avoid contact sport

  16. 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

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