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Saturday, December 28, 2013

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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