Spinal pathology

Question 1

Spondylolisthesis

Answer 1

Displacement of one vertebra relative to another
Most common L4/L5
Presents with back pain, relieved by rest and sitting leg pain and neurogenic claudication

Ix - X ray, MRI

Mx
Conservative - physio, NSAID, epidural steroid injection
Surgical - lumbar decompression with fusion

N.B. Spondylolysis is a stress fracture in the pars interarticularis

Question 2

Scoliosis

Answer 2

10:1 ratio girls
Right thoracic curve most common
Adams forward bend test positive

Ix - Xray, MRI

Mx - Observe, brace, spinal fusion

Question 3

Degenerative disc disease

Answer 3

Loss of the disc height, disc weakens, allows shifting of the vertebral bodies and therefore arthritis and spinal stenosis

Leads to back pain anywhere worsened by moving

Ix - Xray, MRI

Mx
Conservative - Physio, NSAID, strength training
Surgical - depends on symptoms