AppearsSpondylolisthesis may be in connection with spine instability or not . Symptoms are not compulsory but some kind of discomfort is felt . The patient may also feel neurogenic claudicating, or pain of different levels of intensity.
There are 5 different types of spondylolisthesis. The first one is congenital and the problem appears in the arch of L5. At the beginning of the patient’s life may appear type 2- isthmic that can ve divided into : acutely fractured, lytic, elongated. If the patient is mature and spondylolisthesis appears, than it may be type 3 – the degenerative one. This type has a strong relation with ageing and the changes that occur when this happens. The fourth type may appear at any time in life due to a injury or trauma. The last type is the pathological one and appears because of a bone disease.
In young adults, spondylolisthesis may be felt like a small back pain, hamstring tightness, difficult hips flection, gait difficulty, hyperlordosis of the lumbar parts.
The treatment of spondylolisthesis depends on the age of the patients and on the problems that may appear. Many patients (especially young ones) are treated without surgery, with immobilization only and the treatment is a success. Traction is used in older patients with a small slip.
Surgery is preferred when some of this situations appear: the slip is higher than 50%, neurogenic claudication or myelopathy, are present, the patient suffers from traumatic or iatrogenic spondylolisthesis, the spondylolisthesis is degenerative or there is a gait abnormality. The surgery has to restore the arrangement of the sagittal, and to decompress.
Before deciding whether the spondylolisthesis should be treated by surgery the doctor has to take into consideration the age of the patient, the slip degree, and the progression risk. In less than 24 hours after the surgery the patient should feel an improvement and is better to avoid anti-inflammatory medications. In order to check the fusion, radiographs will be taken after the surgery as a routine.
Surgery is not indicated if the patient has health problems and the risk is not worth taking. If the patient is a smoker the outcome of the fusion is likely to be bad and the surgery has no justification.
Before surgery the doctor will need a MRI (more accurate than a CT scan) and a bone scan. Sometimes myelography is combined with a CT scan, for lateral recess.
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