DEFINITION OF SPONDYLOLISTHESIS-
Mostly Spondylolisthesis is caused due to an underlying condition of Spondylolysis. It is a condition where one side of vertebral body does slipped forward over a lower segment due to a congenital fracture or defect in the pars interarticularis. Most often at level between the fifth lumbar vertebra and the first sacral vertebra ranges from mild to severe. It may often affect vertebrae in the neck. The backward displacement is also known as “Retrolisthesis”.
Spondylolisthesis derived from two parts; spondylo which means spine, and listhesis which means slippage. Thus, spondylolisthesis means a forward slip of single vertebra over another. There are five kinds of spondylolisthesis; congenital or dysplastic, isthmic or spondylolytic, degenerative, traumatic, and pathological.
The congenital or dysplastic spondylolisthesis occurs when the defect in the posterior part of L5 or S1 and the forward slippage of one vertebra over another is permitted by the abnormal orientation of the bones. It is an unusual condition and is frequently related with neurologic involvement. The severity of subluxation can be graded as given below; Grade 1 is 0% to 25%, Grade 2 is 26% to 50%, Grade 3 is 51% to 75%, and Grade 4 is more than 75% of vertebral slippage as found on x-ray.
The isthmic or spondylolytic spondylolisthesis is very common type of spondylolisthesis. The pars interarticularis is a spondylolysis which is generally a stress fracture in the posterior part of the vertebra which is present in isthmic type of spondylolisthesis. Spondylolysis is very common reason of spondylolisthesis. Mostly, isthmic spondylolisthesis does occurs in the lumbar region, at the level between the 5th lumbar vertebra and the 1st sacral vertebra, which is L5-S1 level.
The degenerative spondylolisthesis is a condition which is very common to the chronic degenerative disc disease and the related changes which may often lead to segmental instability. It is not affected by the pars interarticularis. The degenerative disc disease affects by narrowing the disc space, which allows the supporting structures top become lax and can lead to most common at L4-L5 to segmental instability. As a result, there is persistant subluxation of the facet joints along with the decreased resistance to forward subluxation of one vertebra over another as facet joints are also affected. Degenerative spondylolisthesis most common occurs in women.
Traumatic spondylolisthesis is caused due to a traumatic fracture of the posterior elements of the vertebra, due to destruction of the posterior aspect of the spine through pathological (osteoporosis), tumor, infection and due to postsurgical spondylolisthesis.
SYMPTOMS OF SPONDYLOLISTHESIS-
The following are the symptoms can be seen in spondylolisthesis:-
- Pain in back and buttock can be felt.
- Weakness or numbness can be felt in one leg or sometimes in both.
- Walking can be painful or difficult.
- From the lower back down one or both legs pain runs.
- In some of the cases loss of bladder or bowel control.
- When you bend over or twist pain gets worse in buttock or back, leg.
- Patience characteristically have tight hamstring muscles which is the muscles in the back of the thigh, decreased flexibility in the lower back and pain or difficulty with arching the back backwards
- Sometimes patience may often complain of sciatic pain.
- Normally, in the sitting position the spinal canal is more open, patience do not have alot of pain while sitting. the spinal canal gets smaller in the upright position pinching the nerve roots in the canal and accentuating the stenosis.
CAUSES OF SPONDYLOLISTHESIS-
The causes of spondylolisthesis are based on age, heredity and lifestyle:-
- Some children may often suffer from spondylolisthesis due to birth defect or injury.
- During adolescence, rapid growth may also be a contributing factor.
- Sometimes playing sports like football, gymnastics, weightlifting and track and field may also cause your strain to over stretch and put stress on your lower back.
- When there is a fracture in a vertebra, but it has not yet fallen on to a lower bone in your spine, spondylolysis does occur.
- Sometimes spondylolisthesis may often occurs due to a weakening of the pars, often due to result of a laminectomy.
- As the age grows the parts of your spine degenerate, which can also cause spondylolisthesis.
DIAGNOSIS OF TESTS FOR SPONDYLOLISTHESIS-
To diagnose spondylolysthesis can be found to be difficult as some people don’t have any symptoms or overwhelming pain. Thus, the following tests are necessary:-
- PHYSICAL DIAGNOSIS:-
- SLR:- The Straight Leg Raise physical examination is a neurodynamic and passive test. With this test range of motion of the neurological tissues as well as the sensitivity is checked.
- Tenderness of the lumbar spine is checked by pressing on it.
- Pain does increases or not while standing and does it relieve while sitting or sleeping.
- Gluteal stretch is painful or not.
- IMAGINARY DIAGNOSIS:-
- X-Ray:- An X-ray can be taken by your doctor to diagnose if your spondylolisthesis is moving or unstable. Also the doctor may perform flexion and extension views from the side.
- CT Scan:- To provide a detailed anatomic picture of your lumbar spine, also of the phone, which will help your doctor to identify abnormalities.
HOME TREATMENT FOR SPONDYLOLYSTHESIS-
There are many home treatments which can prevent patients from being operated:-
- Patients can also use hot water bags or ice bags to reduce localized pain. Heat can be applied to relax the muscles and to promote blood flow. Ice can be applied to relive pain.
- Painkillers such as acetaminophen, ibuprofen or oral steroids can be taken to reduce inflammation in the area but with your doctor’s prescription.
PHYSIOTHERAPY TREATMENT FOR SPONDYLOLYSTHESIS-
The following physiotherapy treatment can be provided by your doctor to treat your spondylolysthesis pain:-
- Pelvic tilt
- Dead bug exercise
- Partial curl
- Double knee to chest
- Quadruped arm/leg raise
- Side plank
- Hamstring stretch on wall
- Quadriceps stretch
- Hip adductor stretch
- Isometric hip adduction
- Gluteal stretch
- Ultrasound:- An ultrasound can help to reduce muscle spasms, stiffness, cramping, swelling and pain upto a great extent. It helps by sending sound waves deep inside your tissues creating a gentle heat which increases healing and blood circulation.
- TENS:- A transcutaneous electrical nerve stimulation machine stimulates your muscle with the help of variable intensities of electrical current. It reduces your muscle spasms and increases your body’s production of endorphins, your natural pain killers.
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