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Name of Injury

Figure or Spondy






Spondylolithesis ~
(spon-dee-low-lis-thee-sis)




The word spondylolisthesis derives from two parts - spondylo which means spine, and listhesis which means slippage
Description of Injury

- A forward dislocation of one vertebra over the one beneath it producing pressure on spinal nerves.

Types of Spondylolisthesis.

Developmental Spondylolisthesis
This type of spondylolisthesis may exist at birth, or may develop during childhood, but generally is not noticed until later in childhood or even in adult life.

Acquired Spondylolisthesis
Acquired spondylolisthesis can be caused in one of two ways: i. With all of the daily stresses that are put on a spine, such as carrying heavy items and physical sports, the spine may wear out (i.e., degenerate). As the connections between the vertebrae weaken, this may lead to a spondylolisthesis. ii. A single or repeated force being applied to the spine can cause a spondylolisthesis; for example, the impact of falling off a ladder and landing on your feet, or the regular impact to the spine endured by offensive linemen playing football.
Skeletal Elements Involved


Vertebral column is the area where frcature such as Spondylolisthesis can occur.
Spondylolisthesis - The Anatomy Wiki
Muscle Elements Involved
These muscles can spasm due to the stress on the bone and nerve which cause the contraction to occur.
Spondylolisthesis - The Anatomy Wiki
Ligaments/Tendons/Other

Because no ligament/ tendon or muscle damage is done..

The Symptoms
  • Pain in the low back, especially after exercise
  • Increased lordosis (swayback).
  • Pain and/or weakness in one or both thighs or legs
  • Reduced ability to control bowel and bladder functions
  • Tight hamstring musculature
  • In cases of advanced spondylolisthesis changes may occur in the way people stand and walk; for example, development of a waddling style of walking. This causes the abdomen to protrude further, due to the lowback curving forward more. The torso (chest, etc.) may seem shorter; and muscle spasms in the lowback may occur.


    Cause of Injury
  • Approximately 5-6% of males, and 2-3% of females have a spondylolisthesis.
  • It becomes apparent more often in people who are involved with very physical activities such as weightlifting, gymnastics, or football.
  • Males are more likely than females to develop symptoms from the disorder, primarily due to their engaging in more physical activities. Although some children under the age of five may be pre-disposed towards having a spondylolisthesis, or may indeed already have an undetected spondylolisthesis, it is rare that such young children are diagnosed with spondylolisthesis.
  • Spondylolisthesis becomes more common among 7-10 year olds.
  • The development through their Jr. years, and the wear- and-tear of daily life, result in spondylolisthesis being most common among adolescents and adults

    Treatment
  • Most patients with spondylolisthesis should avoid activities that might cause more stress to the lumbar spine, such as heavy lifting and sports activities like gymnastics, football, competitive swimming, and diving.
  • Patients, or their parents, must discuss their daily activities and hobbies with their physician to see if they are all right to continue
  • Bed rest following an injury to the back is used less and less because of the risk of deconditioning (e.g., loss of muscle tone which delays recovery).
  • "Ten years ago, one of your friends may have had a similar back problem and was placed on bed rest for at least ten days. We now know that a shorter period of time, such as two to three days followed by a guided physical therapy program is a better solution to back pain"
  • In certain situations a corset or brace is useful to provide additional support to the spine. This support may decrease muscle spasm and pain.
  • Surgery is another option if the nonoperative measures (e.g., rest, therapy, bracing), have not improved the recovery process.
  • Drug Therapy
    During the acute phase of low back pain, drugs may be prescribed. Some of these may include narcotics, acetaminophen, anti-inflammatory agents, muscle relaxants, and anti-depressants.
    Narcotics are used on a short-term basis partially due to their addiction potential. When low back pain is caused by muscle spasm, a muscle relaxant may be prescribed. Muscles relaxants are usually used no longer than one week and have sedative effects. Depression can be a factor in chronic low back pain. Anti-depressant drugs have analgesic properties and may improve sleep.
    • Bracing and Physical Therapy
    • Other conservative non-operative treatment may include a custom-made brace. A brace is designed to reduce the loads (weight) to the lumbar spine. Physical therapy may be added to the treatment plan. Forms of therapeutic exercise including stretching may improve the flexibility of the trunk muscles. Other non-aerobic exercises may help to improve muscular endurance, coordination, strength, and facilitate weight loss. Exercise also helps to combat anxiety and depression. brace
    • Disease Progression and Neurologic Deficit
    • Although degenerative spondylolisthesis may cause a vertebra to slip forward, that does not always mean the disorder is progressive. The vertebral segment may be stable without any neurologic compromise. Surgery becomes a consideration when the disorder causes neurologic deficit, such as incontinence or the slip progresses. Spinal fusion and instrumentation may become a consideration if slippage exceeds three millimeters. These surgical procedures stabilize the spinal column.
    • The surgeon bases his/her decisions on the patient's medical history, symptoms, radiographic findings, as well as the degree and angle of the vertebral slip. Patients who use tobacco or are obese are known to have lower rates of success with fusion. Nicotine hampers the fusion process and obesity places excessive weight on the lumbar spine.
    • Spinal Fusion and Instrumentation
    • Spinal fusion and instrumentation are combined. Spinal fusion uses the patient's (preferred) own bone harvested from the iliac crest (pelvis). Donor bone is an option. Spinal instrumentation uses medically designed implants such as screws and cages. The implant(s) holds the vertebral segment secure facilitating fusion. Instrumentation provides more rapid pain relief, recovery, and may eliminate the need for bracing following surgery. Two surgical procedures that utilize spinal fusion and instrumentation are termed Anterior Lumbar Interbody Fusion (ALIF) and Posterior Lumbar Interbody Fusion (PLIF). The difference between the two procedures is the surgical approach to treat the disorder (front or rear).


    surgical brace
    Vocabulary


    Fracture- A fracture is where the composition of the bone is no longer in tact. The integrety of the bone has be compromised in some way.
    References & Links

    2 time NBA MVP Steve Nash suffers from spondylolisthesis.
  • Spondylolisthesis - The Anatomy Wiki

    Spine Universe. Mar 16. http://www.spineuniverse.com/displaygraphic.php/253/ag_010300spinaldisorders_spondybrace5-UU.gif
    Medicine Net. March 16th http://www.medicinenet.com/fracture/article.htm
    (NLM) Government document. April 28thhttp://www.nlm.nih.gov/medlineplus/ency/article/001260.htm
    Spiegel DA, Hosalkar HS, Dormans JP. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 678.
    http://my.clevelandclinic.org/disorders/Back_Pain/hic_Spondylolisthesis.aspx
    http://orthoinfo.aaos.org/topic.cfm?topic=a00053