SPONDYLOLISTHESIS Outcomes q q q Be familiar with

SPONDYLOLISTHESIS

Outcomes q q q 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.

Definition q Anterior displacement (antero-listhesis) of a vertebral body upon the bottom vertebral body q Usually occurs between L 4 -L 5 and between L 5 -S 1 q Generally occurs in families q Posterior displacement: retrolisthesis

Spondylolisthesis

Pathology q In the standing position there is a constant downward and forward force on the lower lumbar vertebrae q Body mass and normal movement may give rise to spondylolisthesis q The anatomical structure of the lumbosacral area of the vertebral column is affected

Pathology q The degree of antero displacement is explained in Grades I to IV q These grades each comprise a quarter of the surface of the bottom vertebrae q Grade I and II is treated conservatively q Grade III and IV should undergo a fusion

Five types q Congenital spondylolisthesis (L 5/S 1) – more common in girls and sometimes associated with spina bifida. q Spondylolytic spondylolisthesis (L 5) – due to bilateral spondylolisthesis q Traumatc spondylolisthesis – due to a fracture of the pars interarticulari e. g. Parachute jumping

Five types q Degenerative spondylolisthesis (L 4) – uncommon before the age of 50 q Pathological spondylolisthesis – after local or general bone diseases e. g. tumour or infections

X-rays

Signs and symptoms Back or leg pain q Back feels weak q Sometimes lumbar scoliosis and increased kyphosis q Step is felt in the back q Unilateral and sometimes bilateral nerve root compression with pain in the legs q Segmental instability q Stiff back extensors, hamstring and m psoas – attempt to stabilise the pelvis q

Signs and symptoms Extension is the most common restricted range q Pain increases during standing especially in high heeled shoes, walking down hill, prone and other extension activities q Experiencing difficulty to come out of flexion, must press on thighs with hands q Extension is painful and restricted q SLR is restricted q Pain relief while sitting, supine and crook-lying (stable positions) q

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

Relief of symptoms q q q Maitland mobilisations (no strong techniques as a result of the instability) Rotation up to Grade IVLongitudinal in flexion Palpation techniques no further than Grade II (be extremely careful) Static traction (27, 5 kg – 35 kg)

Relief of symptoms q Trigger points q Neural mobilisations q Stretch of back extensors and m psoas q Strengthening of abdominal stabilisers, m gluteus and m quadriceps q Re-education of correct posture

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

Advise q Avoid becoming overweight q Wear a corset with painful activities q Housewife must use trolley during shopping q Retain abdominal stabilisation at all times q Comfortable position is usually with pillow underneath the legs