SPONDYLOLISTHESIS

Outcomes Be familiar with the definition of

Spondylolisthesis. Be familiar with the pathology of a typical

Spondylolisthesis. Be familiar with the types of Spondylolisthesis. Be familiar with the clinical presentation of a

typical patient with Spondylolisthesis. Be familiar with the most widely used

physiotherapy treatment protocols for a patient with

typical Spondylolisthesis. Be able to give appropriate advice to a patient with

typical Spondylolisthesis.

Definition Anterior displacement (antero-listhesis) of a

vertebral body upon the bottom vertebral

body Usually occurs between L4-L5 and between L5-S1 Generally occurs in families Posterior displacement: retro- listhesis

Spondylolisthesis

Pathology In the standing position there is a

constant downward and forward force on the lower lumbar vertebrae

Body mass and normal movement may give rise to spondylolisthesis

The anatomical structure of the lumbo-sacral area of the vertebral column is affected

Pathology The degree of antero displacement is

explained in Grades I to IV

These grades each comprise a quarter of the surface of the bottom vertebrae

Grade I and II is treated conservatively

Grade III and IV should undergo a fusion

Five types Congenital spondylolisthesis (L5/S1) –

more common in girls and sometimes associated with spina bifida.

Spondylolytic spondylolisthesis (L5) – due to bilateral spondylolisthesis

Traumatc spondylolisthesis – due to a fracture of the pars interarticulari e.g. Parachute jumping

Five types Degenerative spondylolisthesis (L4) –

uncommon before the age of 50

Pathological spondylolisthesis – after local or general bone diseases e.g. tumour or infections

X-rays

Signs and symptoms Back or leg pain Back feels weak Sometimes lumbar scoliosis and

increased kyphosis Step is felt in the back Unilateral and sometimes bilateral nerve

root compression with pain in the legs Segmental instability Stiff back extensors, hamstring and m

psoas – attempt to stabilise the pelvis

Signs and symptoms Extension is the most common restricted

range Pain increases during standing especially

in high heeled shoes, walking down hill, prone and other extension activities

Experiencing difficulty to come out of flexion, must press on thighs with hands

Extension is painful and restricted SLR is restricted Pain relief while sitting, supine and crook-

lying (stable positions)

Treatment Asymptomatic: No treatment

Symptomatic: Severe cases – bed rest static traction localised heat analgesics

Stable cases – relief of symptoms stabilisation improvement of posture advise

Relief of symptoms

Maitland mobilisations (no strong techniques as a result of the instability) Rotation up to Grade IV- Longitudinal in flexion Palpation techniques no further than Grade II (be extremely careful) Static traction (27,5 kg – 35 kg)

Relief of symptoms Trigger points Neural mobilisations Stretch of back extensors and m

psoas Strengthening of abdominal

stabilisers, m gluteus and m quadriceps

Re-education of correct posture

Advise Sitting is better than standing Avoid running, jumping, horseback

riding and other jerky movements Swimming and cycling are good

exercises Avoid contact sport

Advise

Avoid becoming overweight Wear a corset with painful activities Housewife must use trolley during

shopping Retain abdominal stabilisation at all

times Comfortable position is usually with

pillow underneath the legs