Spondylolisthesis Flashcards
hx
45 yr old F, worsening back pain over previous 2 yrs, analgesics and physio, last weekend more severe w/ shooting pain to both buttocks, no hx or bowel/bladder dysfunction, X-ray 2 yr something unusual, incidental finding of pars defect of L5 on X-ray of lumbar spine
look
possible waddling gait
hyper-lordotic lumbar spine
gluteal muscle atrophy
active movement
decreased forward flexion
Schrobers test
passive and resisted movement
not expected
special tests
SLR restricted bilaterally
Trendelenberg test positive
other tests
full near exam lower limbs normal
DDx
spondylolithesis
spondyloarthropathy
disc prolapse/ herniated nucleus pulposis
malignancy
why is spondylolithesis likely?
bilaterally
hyperlordosis
reduced forward flexion
why is disc prolapse unlikely?
unilateral symptoms
why is spondyloarthropathy unlikely?
inc ankylosing spondylitis and Reiter’s syndrome
low back/buttock pain, morning stiffness, generalised fatigue
why is malignancy unlikely?
wt loss smoking chronic cough bloody sputum cancer hx Beware MM - rest pain, Bence Jones protein, SPEP
Investigations
xray AP and lateral, oblique and flexion extension views of lumbar spine
MRI lumbosacral spine
xray AP and lateral, oblique and flexion extension views of lumbar spine look for
frank spondylolithesis on lateral
pars defect on oblique
pelvic incidence [sacral slope and pelvic tilt]
instability on flexion extension]
MRI lumbosacral spine
neural compression/ foraminal stenosis
non op tx
analgesia
physio
ortho
