Degenerative Spondylolithesis

Question 1

What is the difference between degenerative and isthmic spondylolithesis?

Answer 1

Degenerative involves degeneration of facet and disc whereas isthmic involves a pars interarticularis fracture, or spondylolysis as it is also known (includes stress #).

Question 2

What defines a traumatic spondylolithesis?

Answer 2

Sponylolithesis caused by a traumatic fracture in a region other than the pars interarticularis.

Question 3

What is dysplastic spondylolithesis?

Answer 3

Congenital secondary to malformation or misalignment of the facet joints.

Question 4

What is pathological spondylolithesis?

Answer 4

Causing compromised structural integrity secondary to system (ex. bone or connective tissue) disease or local disease (ex. infection, neoplasm etc.).

Question 5

What is iatrogenic spondylolithesis?

Answer 5

Secondary to excessive removal of posterior portion of vertebrae in laminectomy.

Question 6

Name three risk factors for spondylolithesis.

Answer 6

i) genetics
ii) activities involving repetitive extension and rotation.
iii) pregnancy
iii) hyperlordosis

Question 7

What is an appropriate outcome measure for spondylolithesis? When would it be inappropriate?

Answer 7

Oswestry Disability Index. However, there is a ceiling effect for high level patients.

Question 8

What are 5 key objective tests to help determine the presence of spondylolithesis?

Answer 8

i) ROM: limited AROM globally, pain on end extension and rotation, PPIVMs limited where affected
ii) Functional Test: Golf swing (ext/rot) to reproduce symptoms
iii) Neuro Tests: +ve nerve root signs, possible +ve cord signs, possible +ve SLR due to tensioning
iv) Palpation: step deformity & pain
v) Low Midline Sill Sign: step deformity

Question 9

What are the precautions associated with degenerative spondylolithesis?

Answer 9

i) always use a pillow for prone activities
ii) high impact activities.
iii) end range extension and rotation.

Question 10

What are two differential diagnoses for degernative spondylolithesis and how would you rule them out?

Answer 10

i) Spondylolysis: no neuro signs, +ve Unilateral Extension Test
ii) Lumbar Facet Arthropathy: MAY have neuro signs, +ve Kemp test (only if local pain, radiating only determines presence of nerve root compression).

Question 11

Describe three important treatment options to consider in degenerative spondylolithesis.

Answer 11

i) myofascial release of thoracolumbar fascia and global muscles tight from compensating for core
ii) repeated flexion exercises for analgesia
iii) core stability exercises