Ironically, 62 reported they would undergo the surgery again. The influence of psychosocial factors must be considered in any outcome study, and this retrospective study demonstrates that indeed it is difficult to ascertain whether a poor result is due to inappropriate patient selection process, to the surgical procedure, or to failure of outcome measurement. Prospective studies with clearly defined diagnostic categories would probably produce the greatest improvement to the outcome of lumbar fusions. 12, in a prospective study of degenerative slips, herkowitz showed that an attempted fusion gave better clinical outcomes than decompression alone. 13, the results on isthmic-type spondylolisthesis have been the most promising. Most investigators report a 75-95 rate of good-to-excellent outcome.
Spinal stenosis - wikipedia
These variations best have been attributed to a multitude of factors, from advancements in instrumentation to the understanding of bone healing. Lack of clearly defined indications for fusion has been another contributing factor. The evidence in support of fusion for spondylolistheses types i, ii, iv, and v and iatrogenic spondylolisthesis is strong. Some controversy exists regarding persons with degenerative-type slips (type iii degenerative scoliosis, and mechanical back pain. Very few prospective randomized trials are assessing the long-term outcome of lumbar fusion in these patients. Variables used to evaluate the effectiveness of this procedure have included patient level of function, pain, satisfaction, return to work, and quality of life. Radiographic confirmation of fusion, complications, and cost are other important criteria in the evaluation of the overall outcome. A prospective randomized study performed by Zdeblick et al confirmed that the addition of rigid posterior instrumentation increases the rate of fusion and correlates with less pain and a greater rate of returning to work. 10, 11, in contrast, Franklin retrospectively evaluated writing the outcome of lumbar fusion in patients receiving Workers' compensation in Washington state and found that 68 of patients experienced worsening of back and leg pain, and 56 reported their quality of life had not improved or was. 12, they concluded that the use of instrumentation doubled the risk of a second surgical procedure.
Annals of the royal College owl of Surgeons of England. garrigues, henry jacques (1902). A textbook of the science and art of obstetrics. "Isthmic Spondylolisthesis and Spondylolysis". External links edit retrieved from " ". Lumbar Spinal Stenosis: Spondylolisthesis. Lumbar fusion is being performed with more frequency across the United States, with considerable regional variation.
full citation needed "Spondylolysis and night Spondylolisthesis of the lumbar Spine". Treatment Options for Spondylolisthesis; OrthoConsult Grabias S (1980). The treatment of spinal stenosis". The journal of Bone and joint Surgery. permanent dead link lu vm, kerezoudis p, gilder he, mcCutcheon ba, phan k, bydon M (2017). "Minimally Invasive surgery versus Open Surgery Spinal Fusion for Spondylolisthesis: a systematic review paper and Meta-analysis". Spine (Phila pa 1976). CS1 maint: Multiple names: authors list ( link ) newman ph (1955). "Spondylolisthesis, its cause and effect".
TopicA00588 full citation needed full citation needed a b "Adult Spondylolisthesis in the low Back". American Academy of Orthopaedic Surgeons. Retrieved yrmou e, tsitsopoulos pp, marinopoulos d, tsonidis c, anagnostopoulos i, tsitsopoulos pd (2010). "Spondylolysis: a review and reappraisal". leone ld, lamont dw (1999). "Diagnosis and treatment of severe dysplastic spondylolisthesis". The journal of the American Osteopathic Association.
Spinal Stenosis: Practice Essentials
19 The term spondylolisthesis was coined in 1854 from the Greek σπονδυλος, "spondylos" "vertebra" and λισθός "olisthos" "slipperiness "a slip." 20 see also edit references edit a b c Introduction to chapter 17 in: Thomas. Surgical Management of Spinal Deformities. CS1 maint: Multiple names: authors list ( link ) a b c Page 250 in: Walter. Essentials of Physical Medicine and Rehabilitation (3.). CS1 maint: Multiple names: authors list ( link ) "spondylolisthesisplay". Retrieved., in turn citing: Miller-keane Encyclopedia essays and Dictionary of Medicine, nursing, and Allied health, seventh Edition. Copyright date 2003 Dorland's Medical Dictionary for health Consumers.
Copyright date 2007 The American Heritage medical Dictionary. Copyright date 2007 Mosby's Medical Dictionary, 9th edition McGraw-Hill Concise dictionary of Modern Medicine. Copyright date 2002 Collins Dictionary of Medicine. Copyright date 2005 Frank gaillard. Missing or empty title ( help ) foreman p, griessenauer cj, watanabe k, conklin m, shoja mm, rozzelle cj, loukas m, tubbs rs (2013). "L5 a comprehensive review with an anatomic focus".
15 Anti-inflammatory medications (nsaids) in combination with paracetamol (Tylenol) can be tried initially. If a severe radicular component is present, a short course of oral steroids such as Prednisone or Methylprednisolone can be considered. Epidural steroid injections, either interlaminal or transforaminal, performed under fluoroscopic guidance can help with severe radicular (leg) pain. Lumbosacral orthoses may be of benefit for some patients but should be used on a temporary basis to prevent spinal muscle atrophy and loss of proprioception. Surgical edit degenerative anterolisthesis with spinal stenosis is one of the most common indications for spine surgery (typically a laminectomy ) among older adults.
16 Both minimally invasive and open surgical techniques are used to treat anterolisthesis. 17 Retrolisthesis edit Grade 1 retrolistheses of C3 on C4 and C4 on C5 main article: Retrolisthesis A retrolisthesis is a posterior displacement of one vertebral body with respect to the subjacent vertebra to a degree less than a luxation (dislocation). Retrolistheses are most easily diagnosed on lateral x-ray views of the spine. Views, where care has been taken to expose for a true lateral view without any rotation, offer the best diagnostic quality. Retrolistheses are found most prominently in the cervical spine and lumbar region but can also be seen in the thoracic area. History edit Spondylolisthesis was first described in 1782 by belgian obstetrician Herbinaux. 18 he reported a bony prominence anterior to the sacrum that obstructed the vagina of a small number of patients.
A randomized, controlled Trial of Fusion Surgery for
12 It is the most common form of spondylolisthesis; also called spondylolytic spondylolisthesis, it occurs with a reported prevalence of 57 percent thesis in the us population. A slip or fracture of the intravertebral joint is usually acquired between the ages of 6 and 16 years, but remains unnoticed until adulthood. Roughly 90 percent of these isthmic slips are low-grade (less than 50 percent slip) and 10 percent are high-grade (greater than 50 percent slip). 9 It is divided into three subtypes: 13 A: pars fatigue fracture B: pars elongation due to multiple healed stress effects C: pars acute fracture severity edit Classification by degree of the slippage, as measured as percentage of the width of the vertebral body:. Blue arrow normal pars interarticularis. Red arrow is a break in pars interarticularis Anterolisthesis L5/S1 Treatment edit conservative edit patients with symptomatic isthmic anterolisthesis are initially offered conservative treatment consisting of activity modification, pharmacological intervention, and a physical therapy consultation. Physical therapy can evaluate and address postural and compensatory movement abnormalities.
9 Traumatic anterolisthesis is rare and results from acute fractures in the neural arch, other than the pars. 10 Dysplastic anterolisthesis (a.k.a. Type 1) results from congenital abnormalities of the upper sacral facets or inferior facets of the fifth lumbar modern vertebra, and accounts for 14 to 21 of all anterolisthesis. 11 Isthmic anterolisthesis (a.k.a. Type 2) is caused by a defect in the pars interarticularis but it can also be seen with an elongated pars. Type 5) is caused by either infection or a malignancy. Type 6) is caused by complications after surgery. By location edit Anterolisthesis location includes which vertebrae are involved, and may also specify which parts of the vertebrae are affected. Isthmic anterolisthesis is where there is a defect in the pars interarticularis.
8 Classification edit Anterolisthesis can be categorized by cause, location and severity. By causes edit degenerative anterolisthesis (a.k.a. Type 3) is a disease of the older adult that develops as a result of facet arthritis and joint remodeling. Joint arthritis, and ligamentum flavum weakness, may result in slippage of a vertebra. Degenerative forms are more likely to occur in women, persons older than fifty, and African Americans.
1 2, anterolisthesis commonly involves the fifth lumbar vertebra. 6, backward displacement is called retrolisthesis. Lateral displacement is called lateral listhesis 1 or laterolisthesis. 2, a hangman's fracture is a specific type of spondylolisthesis where the second cervical vertebra (C2) is displaced reviews anteriorly relative to the C3 vertebra due to fractures of the C2 vertebra's pedicles. Anterolisthesis edit signs and symptoms edit symptoms of anterolisthesis include: A general stiffening of the back and a tightening of the hamstrings, with a resulting change in both posture and gait. A leaning-forward or semi- kyphotic posture may be seen, due to compensatory changes. A "waddle" may be seen in more advanced causes, due to compensatory pelvic rotation due to decreased lumbar spine rotation. A result of the change in gait is often a noticeable atrophy in the gluteal muscles due to lack of use. Generalized lower-back pain may also be seen, with intermittent shooting pain from the buttocks to the posterior thigh, and/or lower leg via the sciatic nerve.
Surgical versus Nonsurgical Treatment for Lumbar
From wikipedia, the free encyclopedia, jump to navigation, jump to search. Not to be confused with, spondylosis, spondylitis, gender spondylolysis, or, slipped disk. Spondylolisthesis is the slippage or displacement of one vertebra compared to another. Terminology edit, spondylolisthesis is often defined in the literature as displacement in any direction. 1 2, yet, medical dictionaries usually define spondylolisthesis specifically as the forward or anterior displacement of a vertebra over the vertebra inferior to it (or the sacrum ). 3 4, olisthesis is a term that more explicitly denotes displacement in any direction. 5, forward or anterior displacement can specifically be called anterolisthesis.