Spondys - Lumbar Pathology

Question 1

Spondylosis Overview

Answer 1

• Degenerative (wear and tear) changes of spine
• Osteophyte, bone spur formation
• Number one causative factor for this is postural instability
• Pathophysiology — lower crossed syndrome (ant pelvic tilt, hyperlordosis) from poor posture or repetitive stress (lifting)

Question 2

Spondylosis Treatment

Answer 2

• Stretch rectus femoris, tight trunk extensors, and iliopsoas
• Strengthen glut max and abdominals
• Dynamic stabilization with neutral spine posture — functional based activities (pulls, PNF) while in neutral spine posture
• Ergonomic and body mechanics training
• Stretching and soft tissue work
• Postural re-education

Question 3

Spondylolysis Overview

Answer 3

• A defect or stress fracture in pars interarticularis
• Stress fracture happens due to high stress or prolonged overloading
• Pain with extension (increases pressure/stress on back) — disc herniation gets better with extension so this is a difference between them
• UNILAT in nature — radiculopathy is also unilat but difference between these is radiculopathy has neuro symptoms
• Gets worse at END of day
• OA is different than this because OA is an older population while this is in younger people and is unilat while OA often isn’t

Question 4

Spondylolysis Special Test

Answer 4

• Stork Test — pt stand on one leg (affected leg), have pt then extend the spine
• (+) = reproduction of signs and symptoms

Question 5

Spondylolysis Diagnostic Imaging

Answer 5

• Radiographs — unilat oblique view with scotty dog appearance
• Next best answer would e CT scan if radiograph is not an option

Question 6

Spondylolysis Contraindications

Answer 6

• Hyperextension
• Contralateral rotation / sidebending — this would pull on the pars fracture
• End range motions — this would overstress the pars fracture

Question 7

Spondylolysis Treatment

Answer 7

• Education to avoid provocation (avoid contraindications)
• Postural training (same strengthening and stretching as for lower crossed syndrome)
• Neural pelvis isometrics
• Dynamic / functional stabilization training

Question 8

Spondylolisthesis Overview

Answer 8

• Progression of a pars fracture that leads to slippage of one vertebrae over another
• Pathophysiology — continued high stress or can be repetitive stress that leads to a nonunion fracture
• Pain with extension
• Feeling of instability
• Clunking or clicking
• Step off deformity

Question 9

Spondylolisthesis Special Tests

Answer 9

• Step off sign = find sacrum, feel up to find L5, make sure L5 and sacrum are level, then feel up until there is an indentation where the vertebrae is not in line with the sacrum
• Bilateral lateral radiographs
• CT scan or bone scan

Question 10

Spondylolisthesis — Naming Step Off Deformity

Answer 10

(1) step off name = if the indentation is at L3 then it is an “L3, L4 step off” OR can be written as “L3 step off”
(2) level of slip = this is always one level below the step off — so if the step off is at L3, L4 then level of slip is “L4, L5”