Spondylolysis and Spondylolisthesis

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Questions and Answers

What is spondylolysis defined as?

A condition in which there is a defect in the facet joint of a lumbar vertebra

A condition in which there is a defect in the pedicle of a lumbar vertebra

A condition in which there is a defect in the pars-interarticularis of a lumbar vertebra (correct)

A condition in which there is a defect in the lumbar vertebra

What is the most common direction of the slip in spondylolisthesis?

Lateral

Medial

Forward (correct)

Backward

What is the common site for spondylolisthesis?

T12/L1

C5/C6

L4/L5 and L5/S1 (correct)

L3/L4

What is the structure that locks over the superior facet of the vertebra below?

All of the above Signup and view all the answers

What is the consequence when the pars interarticularis 'gives'?

The vertebra slips forward Signup and view all the answers

What is a type of spondylolisthesis that occurs due to congenital underdevelopment of the superior articular facets?

Congenital Signup and view all the answers

What is a common symptom of spondylolisthesis?

Pain localized to the paraspinal region Signup and view all the answers

What is a sign of spondylolisthesis?

Restricted lumbar range of motion Signup and view all the answers

What was the Experimental group treated with?

Passive stretching of bilateral hip flexors, hamstrings, piriformis, and posterior myofascial release Signup and view all the answers

What was the goal of the exercise program for the Experimental group?

To avoid activities that cause spinal extension Signup and view all the answers

What was the result of the treatment for the Experimental group?

Significant reduction in vertebral slip Signup and view all the answers

What exercise was NOT part of the Experimental group's treatment?

Lumbosacral bracing during traveling Signup and view all the answers

What was the focus of the postural awareness instruction for the Experimental group?

To maintain normal posture Signup and view all the answers

What type of instruction was given to the Experimental group regarding activities?

To avoid activities that cause spinal extension Signup and view all the answers

What was the focus of the exercise program for the Experimental group?

Maintaining normal posture and reducing vertebral slip Signup and view all the answers

What was part of the home exercise program for the Experimental group?

Williams flexion exercise and posterior pelvic tilting exercise Signup and view all the answers

What is a characteristic gait pattern observed in individuals with this condition?

Short-stride gait with a pelvic waddle Signup and view all the answers

What is the primary reason for using a lumbo-sacral support in non-operative treatment?

To provide abdominal compression Signup and view all the answers

What is the primary goal of operative intervention in this condition?

To release the nerve roots and fuse the affected segments of the spinal column Signup and view all the answers

What is the effect of sitting on pain in this condition?

Sitting initially relieves but later aggravates pain Signup and view all the answers

What is the primary purpose of advising on posture, back care, and lifting in non-operative treatment?

To prevent further strain and injury Signup and view all the answers

What is the effect of prolonged standing and activity on pain in this condition?

Prolonged standing and activity aggravate pain Signup and view all the answers

What is the effect of lying on pain in this condition?

Lying relieves pain Signup and view all the answers

What is the primary role of mobilizations and soft-tissue techniques in non-operative treatment?

To restore movement to levels of the lumbar spine above the level of the lesion Signup and view all the answers

Study Notes

Spondylolysis

A condition characterized by a defect in the pars-interarticularis of a lumbar vertebra
Believed to be a stress fracture or congenital abnormality, resulting in fibrous tissue replacing the narrow part of the pars interarticularis

Spondylolisthesis

A condition where the body of a vertebra slips on the one below, usually forwards, but occasionally backwards
Common sites are L5/S1 and L4/L5
Stability of the L4/5/S1 part of the lumbar spine depends on the pedicle, pars interarticularis, and inferior articular facet locking over the superior facet of the vertebra below

Types of Spondylolisthesis

Traumatic
Isthmic (resulting from spondylolysis)
Congenital
Degenerative
Pathological

Causes of Spondylolisthesis

Spondylolysis leading to separation of the pars interarticularis
Degenerative changes leading to subluxation of the facet joints
Congenital underdevelopment of the superior articular facets
Fracture due to trauma
Pathological weakening of bone (e.g., malignant or osteoporosis)

Signs and Symptoms

Low back pain and neurogenic leg symptoms
Pain commonly localized to the paraspinal region, gluteal, and posterior aspect of the thighs
Restricted lumbar range of motion, paraspinal muscle spasm, and posterior tilting of the pelvis
Characteristic pelvic 'waddle' may be observed
Pain relieved on lying and aggravated by prolonged standing and activity
Pain reproduced with the one-legged standing lumbar extension test

Treatment

Non-operative treatment:
- Pain relief with warmth and heating
- Lumbo-sacral support to relieve pain
- Active exercises to strengthen abdominal and back extensor muscles
- Advice on posture, back care, and lifting
- Loss of weight if necessary
- Mobilizations and soft-tissue techniques to restore movement to levels of the lumbar spine above the level of the lesion
Operative treatment:
- Decompression of nerve roots and spinal fusion of affected segments
- Indicated for severe symptoms

Experimental Treatment

Passive stretching of bilateral hip flexors, hamstrings, piriformis, and Williams flexion exercises
Myofascial release, posterior pelvic tilt exercise, central PA mobilization of the thoracic spine
Significant reduction in vertebral slip percentage from pre-treatment to post-treatment measurement

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Description

Learn about Spondylolysis, a condition causing defects in lumbar vertebrae, and Spondylolisthesis, a condition where a vertebra slips out of place.