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  • Congenital spondylolisthesis
  • Isthmic spondylolisthesis
  • Degenerative spondylolisthesis
  • Traumatic spondylolisthesis
  • Pathologic spondylolisthesis
  • Spondylolisthesis aquista

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  • 738.4 Acquired spondylolisthesis
  • 756.12 Spondylolisthesis congenital

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  • M43.10 Spondylolisthesis, site unspecified
  • Q76.2 Congenital spondylolisthesis

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Description

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  • Anterior (forward) translation of a vertebra
  • Fracture of the pedicles on vertebra below
  • Slipping of the vertebra in relationship to vertebra below
  • Neurogenic claudication
  • Fracture widens at the pars
  • Congenital spondylolisthesis
    • Dysplasia of the L5 vertebra and sacral arches
  • Isthmic spondylolisthesis
    • Acute fracture, stress fracture, elongation of the pars
  • Degenerative spondylolisthesis
    • Wear and tear to L4-L5 vertebrae
  • Traumatic spondylolisthesis
    • Fracture or acute dislocation of the zygapophysial joint
  • Pathologic spondylolisthesis
    • Systemic disease causing weakness
  • Spondylolisthesis aquista
    • Surgical disruption of the ligament or bone

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Essentials of Diagnosis

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General Considerations

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Demographics

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  • Can be congenital or acquired

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Signs and Symptoms

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  • Pain in lumbar, hip, buttock, leg, lower extremity; parasthesia often radiating into the foot
  • Stiffness along spine
  • Pain in lumbar spine worsens with extension
  • Diminished sensation, motor control, reflexes in the distribution of involved nerve
  • Neurogenic claudication

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Functional Implications

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  • Difficulty maintaining standing postures secondary to back and leg pain
  • Inability to sleep on back
  • Weakness with lifting, prolonged standing
  • Loss of movement or feeling in lower extremity
  • Loss of bowel and bladder control if severe
  • Difficulty with movements (as with driving, twisting) secondary to pain
  • Limit sports participation

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Possible Contributing Causes

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  • Increased lumbar lordosis posture due to tight hip flexors, weak abdominal muscles
  • Congenital
  • Car accident, hit from rear

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Differential Diagnosis

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  • Peripheral nerve impairment
  • Piriformis syndrome
  • Hip pathology with radiating pain pattern
  • Spinal tumor
  • Infection
  • Peripheral neuropathy
  • Sciatica
  • Paraspinal spasms
  • Degenerative disk disease
  • Sacral or pelvic dysfunction

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Imaging

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  • MRI helps to visualize compressed or inflamed nerve root in diagnosis
  • X-ray/plain-film radiograph to see vertebra position, (Scottie dog collar)
  • CT to show herniation compressing the spinal canal/nerves
  • Electrodiagnostic/nerve conduction testing can help to determine specific impaired nerve function

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