Diagnosing and Treating Spondylolisthesis
Since there can be so many different causes of back pain, an accurate diagnosis
is very important. People usually see their primary care physician or
general practitioner first about their back pain; that doctor will probably
perform a physical exam first and then order imaging tests to see what’s
causing the pain.
X-ray: an X-ray can show which vertebrae have slipped out of place.
Computerized tomography (CT) is a noninvasive procedure that uses x-rays to produce a three-dimensional
image of the spine. A CT shows more detail than an X-ray, and can identify
any fractures of the bone.
Magnetic resonance imaging (MRI): An MRI uses magnetic fields and radio-frequency waves to create an image
of the spine, and can reveal fine details of the spine, including nerves,
tumors, and other details. An MRI scan can show details in the spine that
can’t normally be seen on an X-ray. Sometimes a contrast agent is
injected into a vein in the hand or arm during the test, which highlights
certain tissues and structures to make tumor identification clearer.
Myelogram: This test uses a dye that is injected directly into the spinal column,
and is used in conjunction with an X-ray or CT Scan.
Once diagnosed, spondylolisthesis is graded based on the degree of the slippage:
- Grade I — 1 - 25 percent slip
- Grade II — 26 - 50 percent slip
- Grade III — 51 - 75 percent slip
- Grade IV — 76 - 100 percent slip
Grades I and II are usually treated initially with conservative and non-invasive
measures. Grades III and IV may require earlier surgery, depending on
the symptoms (see Surgery for Spondylolisthesis).
Treatments for spondylolisthesis vary depending on the grade of the slippage,
severity of the condition, and the age and health of the patient. Non-invasive,
conservative treatment options include:
- Avoiding heavy lifting or strenuous activities
- Non-steroidal medications such as ibuprofen to reduce milder inflammation and pain
- Steroid injections to reduce more serious inflammation and pain
- Bracing to stabilize the spine and reduce pain
Physical therapy to strengthen the core muscles surrounding the spine
and encourage newer, pain-free ways of moving. Physical therapy is usually
prescribed in approximately 8- to 12-week regimens.)
Surgery: If conservative treatments offer no relief, then surgery may be required.
The goal of surgery is to relieve nerve pain, stabilize the spine, and
increase a person’s ability to move.
Spine surgery has advanced in recent years so that many procedures are
minimally invasive. This type of minimal access surgery causes less trauma
than older surgical methods and requires much less time in the hospital.
The incision is smaller and avoids muscle trauma, which allows patients
to resume regular activity within a short period of time. Surgery for
spondylolisthesis is best performed at a major spine center with doctors
trained and experienced in the most up-to-date, minimally invasive techniques.
Minimally invasive surgery means a quick recovery, less pain, and less
Surgery for Spondylolisthesis.)
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