Unit 6 power point Presentation final

Isthmic Spondylolisthesis: 

Isthmic Spondylolisthesis Laksman Shapiro Victor Ramos 2 /12/12

Description : 

Description The pars interarticularis , also known as the isthmus, is the portion of the vertebrae that connects the lamina with vertebral body With compromise of the ithmus , slippage or subluxation of one vertebral body may occur in reference to the inferior neighboring vertebral body The most common form of isthmus spondylolisthesis is due to a bilateral fracture of the pars interarticularis . This will be the main focus of the presentation

Signs: 

Signs Palpable step in standing -Anterograde: level above the involved vertebrae. Hypertonicity of musculature at effected level

Stable vs Unstable: 

Stable vs Unstable Paris defines instability pertaining to a spinal segment signs of as follows: - “Sudden aberrant motions are observed during active movements of the lumbar spine -A change in the relative position of adjacent vertebrae is detected with palpation performed with the patient in a standing position versus palpation performed with the patient in a prone position”. 3

Symptoms: 

Symptoms B ack pain - worsens over the course of the day. bilateral neurogenic claudication -leg pain is exacerbated with walking and alleviated by forward flexion of the spine E xtreme cases - symptoms involving bowel and bladder control may occur

Causes and Incidence: 

Causes and Incidence Repetitive over load T orque motions involving extension and rotation Most prevalent in weight lifters, gymnasts, springboard divers

Diagnosis: 

Diagnosis Imaging clinical signs and symptoms

Imaging: 

Imaging Bone scanning Modern CT scanning

Imaging Findings: 

Imaging Findings Scotty dog fracture

Imaging Findings: 

Imaging Findings Meyerding scale  Grade I (0–25% subluxation ) Grade II (25–50% subluxation) Grade III (50–75% subluxation ) Grade IV (75% subluxation )

Imaging Findings: 

Imaging Findings

Prognosis: 

Prognosis Conservative treatment is successful in the majority of cases Surgical intervention is reserved for individuals who don’t benefit from conservative treatment

Prognosis: 

Prognosis “In one study, 82 adolescents with symptomatic spondylolysis or spondylolisthesis were treated nonoperatively . In a follow-up period of 1 to 14.3 years, only 25 patients required surgical treatment for pain. Of those with Meyerding Grade I or II subluxation, resolution of pain occurred in approximately 70% after conservative therapies .” 5

Functional Limitations: 

Functional Limitations weight bearing and lifting Extension activities Any other activities that may exacerbate symptoms

Management of Acute Dysfunction : 

Management of Acute Dysfunction Objective: Healing of fracture Restricting activities to pain free limits Antilordotic bracing 8-12 weeks Post bracing, 4-6 weeks core stabilization and reconditioning program before returning to previous level of function and activity.

Management of chronic Dysfunction : 

Management of chronic Dysfunction Objective: Symptom Reduction Postural awareness Core stabilization program Back school: Ergonomic modifications N onsteroidal medications

Surgery: 

Surgery If conservative treatment is non effective, the final option is surgery. Operative interventions: -Decompression -Fusion

Plain X-Ray: 

Plain X-Ray .

CT Scan: 

CT Scan

Possible Biomechanical and Physical impairments based on image findings : 

Possible Biomechanical and Physical impairments based on image findings Excessive lordotic posture Hypermobility at the level of impairment Hypomobility above and below the level of impairment Muscle guarding and hypertrophy at site of impairment B ilateral neurogenic claudication

References: 

References 1 Ganju , A. (2002). Isthmic spondylisthesis . Neurosurg Focus ; 13(1): pp. 1-6 2 Motley, G., Nyland , J., Jacobs, J., Caborn , D., (1998) The Pars Interarticularis Stress Reaction, Spondylolysis , and Spondylolisthesis Progression. Journal of Athletic Training; 33(4):351-358 3 Fritz, J., Erhard, R., Hagan, B. (1998) Segmental Instability of the Lumbar Spine . Physical Therapy; 78(8): pp. 889-896 4 Frymoyer , J. (1994) Degenerative Spondylolisthesis : Diagnosis and Treatment. Journal of the American Academy of Orthopaedic Surgeons; 2(1): pp. 9-15 5 Pizzutillo , P., Hummer, C. (1989) Nonoperative treatment for painful adolescent spondylolysis or spondylolisthesis . J Pedi- atr Orthop 9: 538– 540

References cont.: 

References cont. 6 Paris, S. (2009). S1 Introduction to Spinal Evaluation and Manipulation, ed 4. St. Augustine, FL, University of St. Augustine 7 CT scan of Pars fracture; Orthosports ; http://www.orthosports.com.au/content_common/pg-cricket- injuries.seo ; 2009; February 10, 2012 8 X-Ray; Orthoinfo ; http://orthoinfo.aaos.org/topic.cfm?topic= A00588 ; 2010; February 10, 2012

2 questions: 

2 questions 1) What type of exercises would you use in a core stabilization program and why? 2) What outcome measures would you use to confirm that your patient is responding appropriately to your physical therapy rehabilitation program?