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Medical Media Images presents a Patient Information Article: Lumbar Spondylolisthesis (Abnormal Shift between the Low Back Vertebrae) - Part II

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                         Lumbar Spondylolisthesis - Part - II
                             (Abnormal Shift between the Low-Back Vertebrae)




     
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       What Symptoms can a Lumbar Spondylolisthesis cause?

Here are some of the common symptoms from this condition:

a.     Low back pain and stiffness

b.     Low back spasms

c.      Shooting pain into the legs

d.     Leg numbness and tingling

e.     Leg weakness

f.       A slipping or unstable feeling in the low back

g.     Pain when changing from a sitting to standing position

h.     Pain when bending forward and backward

 

 

How is a Lumbar Spondylolisthesis diagnosed?

 

 

Spine specialists use information from the patient history, physical examination and special tests to make this diagnosis:

1.     History

Patients often complain about frequent episodes of low-back pain, especially after bending forward and backward. Some patients have feelings of instability in the spine. 

2.     Physical Examination

Here are some physical examination techniques used by doctors to diagnose a spondylolisthesis:

1.     Touch and pressure on the spine (palpation)

2.     Testing the spine’s motion (range of motion exam)

3.     Gait testing

4.     Sensation (sensory) testing in the legs

5.     Strength (motor) testing in the legs

6.     Reflex testing in the legs

7.     Straight Leg Raising test (Lesague’s sign)

 

               

                  3. Imaging

 

Spine imaging is usually the best way to diagnose a lumbar spondylolisthesis.

a. X-Rays

 

X-Rays of the spine will show the bone anatomy of the spine. A shift between the vertebrae in a spondylolisthesis can be easily seen on an X-Ray from the side (lateral).

Bending films, where X-Rays are taken with the patient bending forward (flexion) and backward (extension) can show if the spine is unstable and shifts back and forth.

This Color X-Ray Image shows the Lumbar Spine (low back) from the side. The front of the Spine is to the left. The red dotted lines show a shift between the Vertebrae. This is called a "Spondylolisthesis".

 

b. CT-Scans

A CT-scan shows bone anatomy in more detail than an X-Ray.

The spondylolisthesis shift can be clearly seen on a CT Scan. However since a X-Ray will show this as well, CT Scans are rarely necessary to make the diagnosis of a spondylolisthesis. The high dose of radiation also has to be taken into account.  

 

                                                                                                                             

c. MRI Scans

MRI scans can show a spondylolisthesis. They are often taken to see what kind of a problem the spondylolisthesis is causing inside the spine. The discs, spinal nerves, spinal cord can all be seen on an MRI. The compression of the spinal nerve in the nerve channels can be clearly seen.

 

 

 

This Color MRI Image shows the shift between two Lumbar (low back) Vertebrae.

 

 

 

What are the Treatments for a Lumbar Spondylolisthesis?

 

 

1. Non-Surgical Care

Here are some common treatments available for patients not requiring surgery:

a.     Alternative Health Care

              Alternative Health care options can often complement conventional medical care. Massage Therapy, Acupuncture, Meditation exercises and Herbal Remedies can all help with the pain from this condition. Massage therapy can help with the muscle part of the painful process from a spondylolisthesis.

b.     Nutrition and Weight Loss

     Proper nutrition and weight loss can have a positive impact on many spine conditions. Excess weight on the spine often contributes to the symptoms of pain and spasms (Spine and Obesity).

c.      Chiropractic Care

Chiropractic care including manipulation and adjustments of the spine can help with the pain and spasms from this condition.

d.     Spine Exercises

Spine exercises can help with the muscle pain and tightness from this condition. Exercise also increases the amount of oxygen delivered to the spine which can help with healing. Pilates, Yoga and T’ai Chi can help maintain the spine’s flexibility.

 

e.     Physical Therapy (PT)

PT has many modalities to offer for this condition. They can range from Manual Therapy and Exercises to Traction and Ultrasound Treatments. PT usually focuses on core strengthening techniques of the spine. Supporting and conditioning the core muscles of the spine can add stability and improve the symptoms.

f.       Self Help Tools

Self Help Tools are items which can be purchased to help with back pain. They range from Back Braces to Back Mattresses and Ergonomic Devices such as chairs and computer accessories. A spinal brace can be very useful in adding stability for patients who have an unstable spine where there is frequent shifting between the Vertebrae.

g.     Spine Medications

Here are some of the common groups of medications which are available for this condition:

                 Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

                 Muscle Relaxants

                 Pain Killers

                 Nerve pain medications

                         Antidepressants

 

               

h.     Injections

Here are some possible spinal injections which can help with the pain from a lumbar spondylolisthesis:

1.     Lumbar Interlaminar Epidural Steroid Injection

2.     Lumbar Transforaminal Epidural Steroid Injection

3.     Lumbar Nerve Root Block

4.     Lumbar Facet Joint Injection

5.     Lumbar Medial Branch Block

6.     Lumbar Facet Joint Radiofrequency Rhizotomy

7.     Caudal Epidural Steroid Injection

 

 

 

 

2.     Surgical Care

Surgery for this condition is usually done for severe back pain or neurological problems from spinal nerve compression. Here are some possible surgical options:

          

1. Lumbar Laminectomy Decompression

2. Lumbar Fusion

3. Lumbar Laminotomy and Foraminotomy

             

 

 

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Medical Media Images does NOT dispense medical or legal advice. Our images, text and any content cannot be used for diagnosis or treatment of a medical condition. All Images and content are for information purposes only. You must consult with your physician if you need medical advice. Medical Media Images is not a substitute for medical advice.

 

 

 

 

 

 

 

New Interactive Color MRI: Prestige Cervical Disc Replacement in Motion

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Medical Media Images presents a Patient Information Article: Lumbar Spondylolisthesis (Abnormal Shift between the Low Back Vertebrae) - Part I

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                           Lumbar Spondylolisthesis
                     (Abnormal Shift between the Low Back Vertebrae)



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                    What does "Lumbar Spondylolisthesis" mean?

The word “Lumbar spondylolisthesis” is a combination of the Greek words “spondylos”, meaning “spine”, and “listhesis” meaning “slippage”. Altogether Lumbar Spondylolisthesis means a Slippage between the Vertebrae.

 

 

                               What is a Lumbar Spondylolisthesis?

One vertebra slips forward or backward on another. This slippage can cause nerve compression at that segment of the spine. Patients with this condition may experience a combination of back pain and leg pain.

 

 

Does the Spine shift back and forth in a Spondylolisthesis?

The condition of a spondylolisthesis can be divided into those which are stable versus unstable. In an unstable condition, the vertebrae can shift back and forth when the spine moves or with weight-bearing. Patients with an unstable Spondylolisthesis are more likely to have symptoms. Overall only a fraction of the patients who have a Lumbar Spondylolisthesis will be unstable.

 

 

What happens when the Vertebrae shift in a Spondylolisthesis?

When vertebrae shift on each other, several things can happen in the spine:

1.     The discs are stressed since they are attached at the top and bottom sides of the vertebrae which shift. This can cause low-back pain, or even a disc herniation.

2.     The facet joints in the back of the spine can be stressed and pulled apart. This can cause facet joint pain.

3.     The foramen through which the spinal nerve travels often gets smaller in a Lumbar Spondylolisthesis. This can trap the spinal nerve and cause leg pain (sciatica).

 

 

What are the different types of Lumbar Spondylolisthesis?

1.     Congenital Spondylolisthesis

These patients will be born with the condition. This condition is also called a “dysplastic spondylolisthesis”. Children are born with a spinal malformation which causes a shift between the vertebrae. This is a rare condition.

2.     Isthmic Spondylolisthesis

This type of spondylolisthesis occurs as a result of a spondylolysis (link) defect. This is the most common form of spondylolisthesis. It occurs in approximately 5-7% of the population.

3.     Degenerative Spondylolisthesis

This type develops as part of an advanced degenerative process of the spine. Typically, the facet joints on the back of the spine become arthritic and form large bone spurs. These bone spurs then begin to push the vertebra forward, causing the shift.

4.     Traumatic

Due to severe spine trauma. Part of the vertebra can be pushed forward due to the force on the spine.

5.     Pathological

Due to a spine cancer which weakens the vertebra.

 

 

 

How is the Severity of a Lumbar Spondylolisthesis determined?

The severity of a Spondylolisthesis is determined by the amount of slippage between the vertebrae (Meyerding grading system):

Grade I: The shift is 0-25% of one vertebra on another

Grade II: The shift is 25-50% of one vertebra on another

Grade III: The shift is 50-75% of one vertebra on another

Grade IV: The shift is 75%-100% of one vertebra on another

A slippage of over 100% means that one vertebra is now completely in front of another. This condition has its own name, spondyloptosis.

 

              Stay tuned for Part - II of our Patient Education series on Lumbar Spondylolisthesis 

 

 

General Disclaimer

Medical Media Images does NOT dispense medical or legal advice. Our images, text and any content cannot be used for diagnosis or treatment of a medical condition. All Images and content are for information purposes only. You must consult with your physician if you need medical advice. Medical Media Images is not a substitute for medical advice.

 

 

 

 

New Interactive Image: Color MRI showing Cervical Spinal Stenosis (Narrowing of the Nerve Channel in the Neck)

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Interactive Color X-Ray Image of Degenerated Knee Joints!

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Interactive Color MRI: Cervical Disc Degeneration

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New Color MRI Image featuring Cervical Degenerative Disc Disease (Disc Degeneration in the Neck).

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New Color MRI Image: Lumbar Degenerative Disc Disease (Degeneration of the Disc in the low Back)

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Lumbar Spondylolisthesis as an Interactive Color MRI created by MMI

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Interactive Lumbar Kyphoplasty Color MRI Image created

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Patient Education Article: Sacroiliac Joint Dysfunction - Part II

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                                     Sacroiliac Joint Dysfunction - Part II

How do Spine Specialists make the diagnosis of Sacro-iliac Joint Dysfunction?

Spine specialists use the information from the patient history, physical examination, and special tests to make this diagnosis:

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1.     History

In severe and acute cases of sacriliitis, a patient will come to the doctor with fevers and severe pain in the low back/buttock area. They will often have a strong limp, and very little mobility of the hip. These patients may have a recent history of infection.

With the more chronic type of sacroiliac joint dysfunction, the patient will complain of nagging pain in the low back/buttock area and have a difficult time with stair climbing or standing. Some of these patients will have a history of trauma to the pelvis, a type of arthritis, or previous pregnancy.

 

 

2.     Physical Examination

Here are some physical examination techniques the doctor might use to help make a diagnosis:

o   Looking at the spine and pelvis to look for areas of swelling, redness or asymmetry (inspection)

o   Measure the length of each leg

o   Look at the height of the top of each hip bone (iliac crest)

o   Touch and pressure over the sacroiliac joint (palpation)

o   Gaenslen’s test

o   FABERE’s test

o   Patrick’s test

o   Pelvic Rock test

 

3. Imaging

a. X-Ray

X-Rays will show the sacroiliac joints. However, they often will not show a problem with the joint until a sacroiliac joint dysfunction or sacroiliitis is very advanced. It can take 10 years or more for that to be the case.

This Color X-Ray Image shows the Sacroiliac Joints in white. They are located between the Pelvis (Hip Bone) and the Sacrum (Tail Bone).

 

b. Cat Scan

CT-Scans can show the anatomy of the sacroiliac joint very clearly and with better quality than an X-Ray. However, similar to X-Rays it may not show a problem until it is advanced. The CT scan also does not show inflammation in the joint.

This Image is a Color CT Scan showing the Sacroiliac Joints

 

 

c. MRI Scan

MRI scans can show swelling and inflammation in the joint when special MRI images are taken. These are called STIR (Short Tau Inversion Recovery) images and those taken with intravenous contrast (Gadolinium). Both can show inflammation in the Sacroiliac Joint.

d. Nuclear Bone Scan

A nuclear bone scan can show severe inflammation in the form of activity in the joint. However, bone scans are usually not taken for sacroiliac joint dysfunction.

e. Diagnostic Injection

To diagnose a sacroiliac joint dysfunction or sacroiliitis, a doctor can inject the joint with the help of an X-Ray machine. Often a local anesthetic combined with an anti-inflammatory medication such as a steroid is injected. The patient is then evaluated for pain relief.

f. Laboratory Tests

Sometimes doctors will use lab tests to find a cause of sacroiliitis. Here are some possible examples:

-   Complete Blood Count with differential (CBC with Diff):
 This is a blood test which looks for elevated White Blood Cells and other more specialized cells (i.e. Neutrophils) which can be elevated in infection.
- Sedimentation Rate (Sed. Rate):
This blood test looks for severe inflammation.
- C-Reactive Protein (CRP):
This test also looks for severe inflammation.


How is Sacroiliac Joint Disease Treated?

1.     Non-Surgical Treatments

a.     Alternative Health Care
Alternative Health care options can often complement conventional medical care. Massage Therapy, Acupuncture, Meditation exercises and Herbal Remedies can all help with the pain from this condition.

b.     Nutrition and Weight Loss
Proper nutrition and weight loss can have a positive impact on many spine conditions. Excess weight on the spine often contributes to the symptoms of pain and spasms (Spine and Obesity).

c.      Chiropractic Care
Chiropractic care including manipulation and adjustments of the spine can help with the pain and spasms from this condition.

d.     Spine Exercises
Spine exercises can help with the muscle pain and tightness from this condition. Exercise also increases the amount of oxygen delivered to the spine which can help with healing. Pilates, Yoga and T’ai Chi can help maintain the spine’s flexibility.

 

e.     Physical Therapy (PT)
PT has many modalities to offer for this condition. They can range from Manual Therapy to Exercises and Ultrasound Treatments. Mobilizing the joint and strengthening the muscles around the joint are frequent ways Physical Therapists will treat sacroiliac joint inflammation. Joint mobilization techniques can be manipulation, stretching and exercises.

 

f.       Self Help Tools
Self Help Tools are items which can be purchased to help with back pain. They range from Back Braces to Back Mattresses and Ergonomic Devices such as chairs and computer accessories. A specific Sacroiliac Belt is also available.
 
g.     Spine Medications

          i.      NSAIDS (Non-Steroidal Antiinflammatory Medications)

         ii.      Steroids

         iii.      Pain Killers

        iv.      Muscle Relaxants

        v.      Antidepressants

       vi.      Topical Medications

 

 

 

h. Injections

 

Here are some commonly offered injections for chronic Sacroilieitis:

 

o   Sacroiliac joint injection

o   Sacroiliac Joint Radiofrequency Ablation

 

 2. Surgical Treatments 

 

 

In very severe and chronic cases of a sacroiliac joint dysfunction

or  sacroiliitis, surgery can be performed. The surgery relies on

permanently immobilizing the joint. There are sacroliliac joint fusion

techniques available:
 

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General Disclaimer

Medical Media Images does NOT dispense medical or legal advice. Our images, text and any content cannot be used for diagnosis or treatment of a medical condition. All Images and content are for information purposes only. You must consult with your physician if you need medical advice. Medical Media Images is not a substitute for medical advice.