Spondylolisthesis Treatment - News Medical
Spondylolisthesis refers to the forward slippage of one vertebral body with respect to the one beneath it. This most commonly occurs at the lumbosacral junction with L5 slipping over S1, but it can occur at higher levels as well. It is classified on the basis of etiology into the following five types :
Retrolisthesis L5 Over S1 Pics Download
The pars interarticularis, or isthmus, resists significant forces during normal motion. The pars may be congenitally defective (isthmic spondylolisthesis as spondylolysis) or may undergo repeated stress under hyperflexion and rotation that results in microfractures. Lumbar lordosis, gravity, posture, high-intensity activities (eg, gymnastics), and genetic factors all play a role in slip development. If a fibrous nonunion forms from an ongoing insult, elongation of the pars and progressive listhesis results; this is observed in another subtype of type 2 (isthmic) spondylolisthesis. In persons with spondylolysis, 30-50% are believed to progress to spondylolisthesis. The most common location is at L5-S1.
It is most common at L5, and most commonly leads to a spondylolisthesis, or “slip”, or L5 on the sacrum.As you can see in the diagram to the right, the pars links the L5 vertebra to the sacrum.
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Although technology continues to improve the performance of surgical treatment, the most challenging task is simply optimal patient selection. As stated previously, clear indications for fusion must be present in order to optimize outcome, and controversies still exist, especially in the treatment of degenerative spondylolisthesis, that must be resolved in a methodic and scientific manner. Prospective randomized studies with independent evaluators probably will produce the greatest improvement to the outcome of lumbar fusions.
About two thirds of adults suffer from low back pain at some time
Correction of the listhesis is associated with risk of neurologic injury, both transient and permanent. Some surgeons prefer to fuse the spine in place rather than to reduce the subluxation. In persons with higher-grade spondylolisthesis, use of interbody grafts is associated with a high rate of complications. However, the use of these devices adds to the stability of the spinal segment, helps with the reduction of the deformity, and helps achieve sagittal balance, thus ensuring better outcome.
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Before surgery is considered for adult patients presenting with degenerative spondylolisthesis, minimal neurologic signs, or mechanical back pain alone, conservative measures should be exhausted, and a thorough evaluation of social and psychological factors should be undertaken.
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Clinical trials are research studies in which new treatments—drugs, diagnostics, procedures, and other therapies—are tested in people to see if they are safe and effective. Research is always being conducted to improve the standard of medical care. Information about current clinical trials, including eligibility, protocol, and locations, are found on the Web. Studies can be sponsored by the National Institutes of Health (see ) as well as private industry and pharmaceutical companies (see ).