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Degenerative Spondylolisthesis - Spine - Orthobullets

57) Rosenberg NJ. Degenerative spondylolisthesis. J Bone Joint Surg [Am] 1975; 57:467-474.

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Isthmic vs Degenerative Spondylolisthesis

Degenerative spondylolisthesis, which was first reported by German researchers back in the 1930s, [55] is a potentially painful condition of the spine that occurs when the degenerated facet joints of the affected vertebra fail to stop , which in turn results a spondylolisthesis (a slip). It is differentiated from isthmic spondylolisthesis by the absence of fracture in the pars interarticularis or the posterior arch.

This animation will show two types of spondylolisthesis, degenerative and isthmic

Jacobsen et al. [59] studied the prevalence (number of people with the condition) of degenerative spondylolisthesis in a population of over 4000 people (all of these folks had been x-rayed) and discovered that 6.3% of them, mostly females (5:1), had this condition. [59]

Degenerative spondylolisthesis, ..

On the other hand, increased age, lumbar lordosis, and BMI (how heavy you are) were all significantly related to the presence of degenerative spondylolisthesis. [59]

Figure 8 is a sagittal radiograph of a 62 year old female with a grade I degenerative spondylolisthesis at L4. Note the anterior translation (slip) of L4 on L5 and the intact pars interarticularis and posterior arch (short red arrows). (*if you're confused, please visit the forthcoming link to learn about .) Therefore, you can tell this is a degenerative spondylolisthesis because there is no fracture line through the pars or posterior arch, as would be expected in an isthmic spondylolisthesis (). Furthermore, the slip is in an elderly female at L4 and does not exceed 30%; all of these findings point to the diagnosis of degenerative spondylolisthesis.

Degenerative spondylolisthesis ..

Just like spondylolysis and isthmic spondylolisthesis, people with degenerative spondylolisthesis often respond well to non-operative care (medication, physical therapy, low-force chiropractic care, acupuncture, lumbar bracing, facet injections, and/or epidural steroid injections). However, for patients who were refractory to such conservative treatment, surgical intervention may be needed. [70]

How do we know that surgery may work better then non-operative (aka, conservative care) for the treatment of degenerative spondylolisthesis that was refractory to conservative care? For the answer, we turn to the medical research:

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  • Degenerative Spondylolisthesis | Clinical Gate

    Overview of the diagnosis and treatment of degenerative spondylolisthesis by the San Diego Center for Spinal Disorders

  • Degenerative form of spondylolisthesis.

    09/08/2010 · The patient has a degenerative spondylolisthesis with associated spinal stenosis at L4/5

  • Degenerative Spondilolisthesis | spondylolisthesis

    09/08/2010 · The clinical presentation is consistent with a degenerative anterior spondylolisthesis ..

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Spondylolisthesis - Degenerative - Atlanta Brain and …

Although not universally accepted, it is believed by some that a degenerative spondylolisthesis occurs because of an anomalous formation of the lumbar-sacral joint. Specifically, there is either not enough lordosis between L5 and the sacrum, or L5 is sacralized. [57] Such anatomy may result in a biomechanical overload of the L4 disc and facet joints, which in turn leads to significant degenerative changes of the facet joints and subsequent slip. [57]

Degenerative Spondylolisthesis - New York Treatment

Because there is no fracture to deal with in degenerative spondylolisthesis, many surgeons once believed that no lumbar fusion was indicated. Instead, a simpler decompression (aka, laminectomy, laminotomy, foraminotomy) was the way to go.

Adult Isthmic Spondylolisthesis - Spine - Orthobullets

Neurogenic claudication (a.k.a., neurogenic intermittent claudication) is one of the more severe complications of isthmic spondylolisthesis (or degenerative spondylolisthesis for that matter) and occurs after prolonged standing or walking. Specifically, the person will experience a progressive increase of lower extremity pain, cramping, and weakness following standing or walking, which is dramatically relieved by sitting down to rest or bending forward at the waist—like when you push a shopping cart {this is called "shopping cart sign"}). [63] this neurogenic intermittent claudication, unlike in central stenosis caused by degenerative spondylolisthesis, typically ONLY AFFECTS ONE LOWER EXTREMITY.

Spondylolisthesis - PhysioWorks

In a landmark and somewhat controversial study, Herkowitz et al. [71] prospectively studied the surgical outcomes of two groups of patients with lumbar degenerative spondylolisthesis with associated stenosis. Specifically, one group (n=25) was treated with laminectomy, and the other group (n=25) was treated with laminectomy plus non-instrumented posterolateral fusion (PLF). Both groups were carefully followed after surgery for a minimum of two years in order to see how they were doing. At the final follow-up, which averaged three years from the date of surgery, the patient's who had undergone fusion plus decompression demonstrated statistically superior clinical outcomes, as compared to the group that had only had decompression. The authors concluded by saying:

What Causes a Spondylolisthesis

"The results of this prospective study clearly demonstrate that decompressive lumbar laminectomy with intertransverse process arthrodesis [PLF] is the operative procedure of choice for patients who have spinal stenosis associated with degenerative lumbar spondylolisthesis at a single level." [71]

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