Case study 17 - #spondylolisthesis #backpain #backsurgery #alif #lumbarfusion #casestudy #sciatica #spinesurgery
Spondylolisthesis occurs when one of the vertebrae in the spine slips out of position.
Usually, this vertebra has slid forward over the vertebra directly below it. Spondylolisthesis is most common in the lower back, and occurs more often in adolescents and adults.
Types and grades
Spondylolisthesis commonly affects the lower back.
Due to the varying degrees and causes of the misalignment, spondylolisthesis is broken down into types and grades. The six main types are based on the cause of the spondylolisthesis.
Type I - In some cases, people are born with spondylolisthesis. A child may also develop the condition naturally during his or her developmental years. In both cases of Type I spondylolisthesis, a child may not experience any symptoms or problems until later in life.
Types II - In Type II, the most common type, there is a problem with a section of the vertebra called the pars interarticularis. Type II is further broken down into the following subtypes:
Type IIA involves many microfractures caused from overuse and hyperextension.
Type IIB involves many microfractures that do not fracture completely and heal with extra bone in place. The extra bone causes stretching and misalignment.
Type IIC is a complete fracture that has been caused by trauma. A sports injury or being in a car accident may cause Type IIC.
The fractures from Type II only become spondylolisthesis if they cause the vertebra to slip forward.
Type III - Type III is associated with aging and the natural wear and tear on a person’s body.
Type IV - Type IV is a fracture that occurs anywhere in a vertebra except in the pars interarticularis region.
Type V - Type V involves tumors on the vertebrae that push on the bones and cause weakness.
Type VI - Type VI is an uncommon spondylolisthesis caused by weakening of the back due to surgery.
Spondylolisthesis is further classified into grades, according to how far out of place the vertebra is. The grades are:
Grade 1: 25 percent of the vertebral body has slipped forward. This is the lowest grade.
Grade 2: Between 25-50 percent of the vertebral body has slipped forward.
Grade 3: Between 50-75 percent of the vertebral body has slipped forward.
Grade 4: Between 75-100 percent of the vertebral body has slipped forward.
Grade 5: The vertebral body has completely fallen off and looks detached.
SYMPTOMS
A person may have had spondylolisthesis since birth and never experienced any symptoms from it. It is common for a person to develop symptoms as they age, however.
Symptoms can range in severity from non-existent to a loss of urination and bowel movement control in more severe cases.
Some of the most common symptoms include:
difficulty walking or running
pain in the lower back or buttocks
pain that travels from the back down one or both legs
weakness in one or both legs
pain in lower back and legs that is aggravated by movement or twisting
tight hamstrings
increased inward curve of the spine, known as lordosis
Causes
The causes of spondylolisthesis vary. Some people are born with a defective vertebra that may not be identified until much later in life. Others experience an injury to the back either repeatedly or on one occasion only.
Knowing the cause can help a doctor determine the type of spondylolisthesis a person has, as well as help determine the best treatment.
Typical causes include:
fractures from injury
joint injury from arthritis or illness
degeneration from overuse or aging
birth defect
spondylolysis, a defect or fracture in the pars interarticularis region
tumors
surgery
Treatment
Treatment options include at-home care, therapies, and possible surgery.
A person can start treatment at home through a variety of methods, including using over-the-counter medication for pain relief.
In cases where overuse has caused the spondylolisthesis, a person should stop any activities that aggravate the pain. Additionally, someone who is overweight might want to consider losing weight, which may help alleviate their symptoms.
A doctor can prescribe additional pain relief and anti-inflammatory medications if necessary. They may also order physical therapy.
Physical therapy will help a person build up core muscles in the midsection of their body and back. Physical therapy can also include stretching to help relieve pain and improve flexibility.
In more extreme cases, a doctor might recommend surgery. Surgery is usually reserved for cases where there is spinal damage, the vertebra continues to slip, or the pain is extreme.
Surgery can remove excessive bones or fuse the vertebrae back together. If surgery is used, a person will need to take the appropriate steps to recover from the procedure afterward.
29 окт 2022
