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  • 738.4 Acquired spondylolisthesis

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  • M43.00 Spondylolysis, site unspecified

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Description

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  • Stress fracture of the pedicles on the vertebra below
  • Tightness or pain across the back region
  • Often no symptoms
  • Weakness in the pars

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Essentials of Diagnosis

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  • Diagnosis made by x-ray
  • Can be acquired or congenital
  • Back pain

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General Considerations

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  • Instability
  • Avoid extension positions that increase symptoms
  • Thin vertebral bone: pars

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Demographics

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  • Onset most often during teenage years
  • Runs in families

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Signs and Symptoms

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  • Back pain
  • Stiffness along spine
  • Pain in lumbar spine worsens with extension

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Functional Implications

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  • Difficulty maintaining standing postures secondary to back pain
  • Inability to sleep flat on back without a pillow
  • Difficulty with movements (bending over) secondary to pain
  • Limit sports participation

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Possible Contributing Causes

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  • Forceful extension as a result of a hit from behind (as in sports)
  • Congenital
  • Car accident, hit from rear
  • Hyperextension of the lumbar spine
  • Increased lordosis posture

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Differential Diagnosis

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  • Peripheral nerve impairment
  • Spinal tumor
  • Peripheral neuropathy
  • Paraspinal spasms
  • Degenerative disk disease
  • Stenosis

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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
  • CT to show herniation compressing the spinal canal/nerves
  • Electrodiagnostic/nerve conduction testing can help to determine a specific impaired nerve function

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  • Stress fracture of the pars

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  • To hospital for imaging
  • To physician for surgical consult if myelopathy suspected
  • To physician for corticosteroid injection
  • To physician for anti-inflammatory medication
  • To orthopedist for lumbar bracing

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  • Restricted mobility of the lumbar spine
  • Hypermobility
  • Noted weakness noted of core musculature

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  • Rest
  • Bracing
  • Ergonomic training
  • Address pain
    • Electrical stimulation
    • Heat/ice
  • Address hypertonicity
    • Soft tissue massage
    • Heat
  • Address muscle weakness
    • Core stability exercises

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  • Patient will be able to
    • Sit with neutral lumbar spine posture for greater than 30 minutes with 0 out of 10 pain rating
    • Stand at work station and perform computer work for 45 minutes with 0 out of 10 pain rating
    • Rotate lumbar spine in order to lift/pick up items off the floor with 0 out of 10 pain rating

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  • Very good with proper ergonomic training, strengthening, and precautions

1. The American Physical Therapy Association. Pattern 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Localized Inflammation. Interactive Guide to Physical Therapist Practice 2003. DOI: 10.2522/ptguide.3.1_5. Accessed March 5, 2012.
2. Dutton M. Dutton's Orthopaedic Examination, Evaluation, and Intervention. 3rd ed. New York, NY: McGraw-Hill; 2012. ...

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