Rehabilitation Program Physical Therapy As a general rule, physical therapy should not be started until after an adequate rest period and once pain with daily activities has subsided. The goals of physical therapy are to decrease extension stresses of the lumbar spine and to strengthen elements that promote an antilordotic posture.
Spondylolysis Spondylothesis grades spondylolisthesis are the most common causes Spondylothesis grades structural back pain in children and adolescents.
Print This Page Share This Page Spondylolysis and spondylolisthesis are the most common causes of structural back pain in children and adolescents. Spondylolysis is classified as dysplasic congenitalisthmic stress fracturedegenerative, or traumatic.
A spondylolysis in a child or adolescent most commonly results from a defect or stress fracture in the pars interarticularis of the vertebra. The pars interarticularis is the part of the vertebra between the superior and inferior facets Figure 1.
The defect in the pars interarticularis may allow anterior forward displacement or slippage of the vertebra which is called spondylolisthesis Figure 2. The slippage is much more common in individuals with bilateral spondylolysis and those with mechanical instability.
The spondylolisthesis is often classified on the degree of the slip with Grade I: Spondylolysis with L5 pars interarticularis fracture Figure 2: Spondylolysis with L5-S1 spondylolisthesis Many people with spondylolysis have no symptoms and do not even know that they have the condition.
The exact cause of spondylolysis is unknown, although certain risk factors have been identified. For example, spondylolysis is much more common in individuals participating in sports that require frequent or persistent hyperextension of the lumbar spine.
These sports include gymnastics, diving, wrestling, weight lifting, and football linemen Figure 3 A-C. It is believed that the repetitive trauma can weaken the pars interarticularis and lead to a spondylolysis. Another theory is that genetics plays a role in the development of the pars defects and spondylolisthesis.
The bone scan can also be useful in differentiating an acute stress reaction spondylolysis from a chronic defect. The most common finding on physical examination is low back pain and pain with extension of the lumbar spine Figure 4.
Hamstring tightness is another very common finding in patients with spondylolysis. Most patients will not have neurological symptoms or referred pain to the lower extremity.
However, there may be radiating pain with or without neurological symptoms numbness, weakness, tingling with higher grades of spondylolisthesis Grade III, IV, and V. Extension of the lumbar spine on physical examination How are Spondylolysis and Spondylolisthesis Treated?
The treatment for spondylolysis and spondylolisthesis is initially conservative and aims to reduce pain and facilitate healing. In addition, a bone stimulator is occasionally used for an acute spondylolysis to facilitate healing Figure 7.
For acute spondylolysis, the antilordotic brace and physical therapy are usually initiated for weeks. It is often advised that sports requiring extensive or repeated hyperextension be avoided if possible. If the patient has persistent symptoms, the above conservative treatments are continued.
CT scan with 3D reconstruction of L5 spondylolysis Figure 5b: MRI scan of Grade IV L5-S1 spondylolisthesis Surgical treatment might be recommended if there is persistent pain despite extensive conservative therapies. Surgical treatment is also often recommended in children who have a severe spondylolisthesis Grade III slip and greater.
This is done to prevent further slippage of the vertebae and chronic pain. There are many different surgical procedures for spondylolysis and spondylolisthesis. Bone stimulator that is occasionally used in the treatment of spondylolysis Figure 7: Direct repair of L5 spondylolysis Figure 8b: L4-L5 Posterior instrumented spinal arthrodesis.Apr 03, · Spondylolisthesis - Back Injury Caused by Trauma from a Car Accident - Douglasville Accident Lawyer Murphy Law Firm, LLC.
There are various grades of spondylolisthesis. Doctors often grade it. Spondylolisthesis is measured in grades (degrees) of slippage. There are 4 grades., each representing 25% slippage.
So, for example, if a patient is measured to have a Grade 2 Spondylolisthesis, this means that the 2 adjacent vertebra maintain a 50% contact with one another. Spondylolysis usually comes first, though not always. The term comes from "spondylo," which means spine, and "lysis," which means to divide.
Spondylolysis is a breakdown or fracture of the narrow bridge between the upper and lower facets, called the pars interarticularis. Spondylolysis is an osseous defect found in both symptomatic and asymptomatic individuals.
It predisposes to pathologic intervertebral subluxation or spondylolisthesis, most commonly occurring at . Spondylolysis (spon-dee-low-lye-sis) is defined as a defect or stress fracture in the pars interarticularis of the vertebral arch. The vast majority of cases occur in the lower lumbar vertebrae (L5), but spondylolysis may also occur in the cervical vertebrae.
Spondylolisthesis treatment depends heavily upon the amount of slippage that has occurred in the spine. The level of slippage is graded on a scale from grade 1 to grade 5, with grade 5 being the most severe.