DOCSLIB.ORG

Differentiating Hip Versus Back Pathology with a Patient Status Post

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Differentiating Hip Versus Back Pathology with a Patient Status Post Maria R. Moore, MSPT, DPT1 Differentiating Hip Versus Back Pathology Mary Ann Wilmarth, PT, DPT, with a Patient Status Post Lumbar OCS, MTC, Cert. MDT, CEAS2 Laminectomy and Fusion: A Case Study Marie B. Corkery, PT, DPT, MHS, FAAOMPT3 1Physical Therapist, Lighthouse Healthcare, Inc, Springfield, VA 2Assistant Professor, DPT Program CPS/BCHS Northeastern University and Chief of PT, Harvard University Health Sciences 3Associate Clinical Professor, Physical Therapy Department, Bouvé College of Health Sciences, Northeastern University, Boston, MA ABSTRACT be especially difficult to differentiate pain Hip arthritis is a much less common Background: In older adults with originating from the low back from pain condition compared to LBP, with estimates normal degenerative changes, it can be dif- originating in the hip. A common example being 3.2% of the population older than ficult to differentiate low back pain from is differentiating degenerative back patholo- 55 years of age.9 Despite the fact that hip hip pain. The purpose of this report is to gies from intraarticular hip pathologies, OA is less common than LBP, the two con- describe the role of differential diagnosis such as hip osteoarthritis (OA). ditions often coexist. Hip OA can cause of hip from back pathology in a patient Low back pain (LBP) is the second most abnormal gait and spinal sagittal plane post lumbar laminectomy and fusion. Case common cause of disability in adults in alignment and is associated with LBP.10 Hip Description: The patient was a 56-year-old the United States.3 More than 80% of the and spine arthritis are also part of the same female seen in physical therapy two months United States population will experience an age-related degenerative process and there- postoperatively. A thorough examination led episode of LBP sometime during their lives,4 fore often coexist.11 In a prospective study to a differential diagnosis of intraarticular making LBP a diagnosis very commonly looking at 344 patients waiting to receive hip pathology and the patient was referred seen by primary care clinicians and physical hip arthroplasties, 49% reported LBP. Of to an orthopaedic specialist. Outcomes: The therapists. Over the past few decades, there these patients, 66% had resolution of back patient was diagnosed with severe right hip has been an increase in the number of medi- symptoms following their hip surgeries.11 osteoarthritis and scheduled for a right hip cal procedures for the low back, including In a study by Hsieh et al,2 LBP was found arthroplasty. Three months after surgery spinal injections and surgery. Among elderly in 21% of patients who were scheduled to the patient had complete resolution of pain Americans, the increase in procedures is receive a hip arthroplasty, and the presence and return of function. Discussion: Physi- closely related to an increase in diagnostic of LBP was statistically more common in cal therapists should always complete dif- imaging.5 Although magnetic resonance those with a longer duration of hip symp- ferential diagnosis and screen for additional imaging (MRI) is highly sensitive, studies toms. In their study of patients with coex- pathologies. Groin pain, decreased hip inter- have questioned the relevance of MRI find- isting lumbar spine and hip pathologies nal rotation, decreased hip strength, and gait ings in terms of specificity and correlation described as hip-spine syndrome, Ben Galim dysfunction are key findings to differentiate with clinical findings.6-8 In one such study, et al10 followed 25 patients with severe hip between back and hip pathology. MRI was performed on 67 individuals who OA and at least moderate LBP. They found had never had an episode of LBP or sciatica. that in the spine and hip regions, both pain Key Words: differential diagnosis, hip In the group that was younger than 60 years and function improved significantly follow- osteoarthritis, hip pain, physical therapy of age, 20% were found to have a herniated ing hip arthroplasties. A key point recog- nucleus pulposus. In the group that was 60 nized by the authors after the study was that INTRODUCTION years of age or older, all but one person dem- in patients with both hip OA and LBP, the Differentiating low back from hip onstrated degeneration or bulging of a disc in hip should be treated first.10 pathology can be difficult due to overlap- at least one lumbar level.6 In another study, Whether a patient is seen by direct access ping pain referral patterns.1 Intraarticular 200 subjects without a history of LBP were or is referred for any type of low back or hip hip pathology can commonly refer pain to given an initial exam and MRI of the low pain, the physical therapist should be cogni- the groin, anterior thigh, buttock, anterior back and were followed over a 5-year period. zant of the potential structures that could be knee, and lateral thigh regions.2 Similarly, Fifty-one subjects developed a new onset causing the patient’s symptoms. As a practic- with lumbar pathology, pain can be referred of LBP and had a new MRI taken within ing autonomous provider, it is the therapist’s into the proximal, middle, and distal ante- 6 to 12 weeks of the pain onset. Only 4% responsibility to perform a medical screen, rior thigh regions from the L1, L2, and L3 of the subjects showed MRI changes with assess regions above and below the involved nerve roots respectively1 and buttock pain probable clinical significance.7 These studies area, and to rule in or rule out other poten- can originate from the L4 and L5 nerve demonstrate the importance of correlating tial conditions. Figure 1 provides an algo- roots. A thorough history and physical exam normal lumbar degenerative changes, such rithm for evaluation of low back versus hip of the low back and hip areas can guide the as joint space narrowing, disc degeneration, pain with differential diagnosis based on the practitioner in establishing the correct diag- stenosis, osteophyte formation, and lumbar location of pain.1 There are other examples nosis in a timely and efficient manner, while spondylolisthesis, with a thorough history in the literature of using an algorithmic helping to avoid the costly care and manage- and clinical exam, especially in older adults approach to help guide the practitioner in ment of misdiagnosis. In older adults with who would be expected to have age-related developing a hip differential diagnosis based normal lumbar degenerative changes, it can degenerative changes. on location of pain and information from 172 Orthopaedic Practice Vol. 26;3:14 backward slip by at least 3 mm. Presurgery, the patient completed approximately one month of physical therapy treatment with a different physical therapist and also had cor- History and ticosteroid injections with minimal relief. Physical The patient completed a 6-week course of Visceral Groin or anterior physical therapy following her back surgery. complaints thigh pain During that postsurgery time, her main complaints included overall right lower Lumbar pain radiating into extremity weakness, hip stiffness, difficulty the buttock or with stairs walking more than one-quarter leg mile, and pain with sitting or standing for Differential diagnosis: Differential diagnosis: longer than 30 minutes. The patient’s pain -­‐diverticulitis/ -­‐osteoarthritis hip and was reported mainly in the right groin area diverticulosis knee as well as the right lateral thigh and the lat- -­‐inFlammatory bowl Differential diagnosis: -­‐avascular necrosis eral and anterior aspects of the right knee disease -­‐sacroiliac joint -­‐adductor, iliopsoas region. -­‐urintary tract infections tendonitis -­‐zygapophyseal joint -­‐nephrolithiasis -­‐septic arthritis -­‐diskogenic Tests and Measures -­‐appendicitis -­‐osteomyelitis -­‐radiculopathy At the initial evaluation, the patient’s -­‐abdominal aortic -­‐metastatic lesions aneurysms -­‐lumbar stenosis resting pain score was 3/10 on the visual -­‐pelvic or femoral -­‐prostatitis -­‐piriformis syndrome fractures analog scale. Her Oswestry Disability Ques- -­‐epididymitis -­‐spondylolisthesis -­‐hip dislocation tionnaire score was 34% and her Roland -­‐hydroceles -­‐lumbosacral -­‐labral tear Morris Questionnaire score was 10 out of plexopathy -­‐varicoceles -­‐peripheral nerve lesion -­‐peripheral nerve 24. Both of these questionnaires are widely -­‐testicular torsions lesion -­‐spinal etiology used to assess pain-related disability in -­‐testicular neoplasms -­‐spine, pelvic or persons with LBP, and both have demon- -­‐ectopic pregnancy femoral fracture strated valid and reliable measures that are -­‐dysmenorrhea responsive to change.14 The patient’s lower -­‐endometriosis Diagnostics: extremity neural screen was negative, dem- -­‐pelvic inFlammatory -­‐X-­‐ray onstrating normal deep tendon reflexes, disease Diagnostics: -­‐MRI normal sensation, no abnormal strength -­‐X-­‐ray -­‐MRI arthrogram findings in the L2-S1 myotomes, and nega- -­‐MRI -­‐EMG tive neural tension in the sciatic and femo- -­‐Bone Scan -­‐Musculoskeletal ultrasound ral nerves. Although her lumbar ROM was Internal -­‐EMG globally limited, it was painfree. Her single medicine -­‐Sed rate, ANA, RA titre -­‐Diagnostic injection consultation -­‐Hip aspiration: cell count, leg static balance was decreased for the right -­‐Musculoskeletal crystals, culture & lower extremity as she was able to maintain ultrasound sensitivity balance for about 5 seconds. Her initial Figure 1. Algorithm for evaluation of low back and hip pain. Reprinted with strength measurements assessed
Load more

Recommended publications
  • Modified Plate-Only Open-Door Laminoplasty Versus Laminectomy and Fusion for the Treatment of Cervical Stenotic Myelopathy
    n Feature Article Modified Plate-only Open-door Laminoplasty Versus Laminectomy and Fusion for the Treatment of Cervical Stenotic Myelopathy LILI YANG, MD; YIFEI GU, MD; JUEQIAN SHI, MD; RUI GAO, MD; YANG LIU, MD; JUN LI, MD; WEN YUAN, MD, PHD abstract Full article available online at Healio.com/Orthopedics. Search: 20121217-23 The purpose of this study was to compare modified plate-only laminoplasty and lami- nectomy and fusion to confirm which of the 2 surgical modalities could achieve a better decompression outcome and whether a significant difference was found in postopera- tive complications. Clinical data were retrospectively reviewed for 141 patients with cervical stenotic myelopathy who underwent plate-only laminoplasty and laminectomy and fusion between November 2007 and June 2010. The extent of decompression was assessed by measuring the cross-sectional area of the dural sac and the distance of spinal cord drift at the 3 most narrowed levels on T2-weighted magnetic resonance imaging. Clinical outcomes and complications were also recorded and compared. Significant en- largement of the dural sac area and spinal cord drift was achieved and well maintained in both groups, but the extent of decompression was greater in patients who underwent Figure: T2-weighted magnetic resonance image laminectomy and fusion; however, a greater decompression did not seem to produce a showing the extent of decompression assessed by better clinical outcome. No significant difference was observed in Japanese Orthopaedic measuring the cross-sectional area of the dural sac Association and Nurick scores between the 2 groups. Patients who underwent plate-only (arrow). laminoplasty showed a better improvement in Neck Dysfunction Index and visual ana- log scale scores.
    [Show full text]
  • Tracheal Perforation in a Neonate: a Devastating
    Letters to Editor Tracheal perforation in a size of endotracheal tube, cuff overinflation, cough and vigorous movements of head and neck.[2,3] neonate: A devastating Neonatal tracheal injury is ascribed to factors like complication following traumatic traumatic delivery, weak trachea, congenital tracheal endotracheal intubation stenosis, ring agenesis, metal stylets, rigid endotracheal tube, excessive external laryngeal pressure and [1,4,5] Sir, prolonged ventilation. Tracheal injury in neonates following endotracheal In our case, rigorous attempts at intubation along with intubation represents an uncommon complication excessive hyperextension of head and neck due to altered rarely described in literature but carries high anatomy are likely to have contributed to tracheal injury. morbidity and a mortality rate of 70%.[1] We describe Multiple attempts at intubation are known to result in a [4] a case of neonatal tracheal perforation following false tract and are related to anterior tracheal lesions. multiple attempts at endotracheal intubation due to an Incidentally, our case was an undiagnosed Pierre unanticipated difficulty in an emergency situation in Robins Sequence. A small receding mandible, tongue an undiagnosed case of Pierre Robin Sequence. immobility and cleft palate are identified as independent factors for difficult airway with a risk of upper airway A 4-week-old female baby presented to the emergency obstruction, difficult mask holding, difficult intubation, department with respiratory difficulty. In view of severe leak through the cleft resulting in inadequate ventilation respiratory distress and desaturation (SpO2- 60%) a as well as passage of the endotracheal tube into the decision was made to provide ventilatory support to cleft.[6] Successful airway management in such situation the neonate.
    [Show full text]
  • 2019 Spine Coding Basics
    2019 Spine Coding Basics Presenter: Kerri Larson, CPC Directory of Coding and Audit Services 2019 Spine Surgery 01 Spine Surgery Terminology & Anatomy 02 Spine Procedures 03 Case Study 04 Diagnosis 05 Q & A Spine Surgery Terminology & Anatomy Spine Surgery Terminology & Anatomy Term Definition Arthrodesis Fusion, or permanent joining, of a joint, or point of union of two musculoskeletal structures, such as two bones Surgical procedure that replaces missing bone with material from the patient's own body, or from an artificial, synthetic, or Bone grafting natural substitute Corpectomy Surgical excision of the main body of a vertebra, one of the interlocking bones of the back. Cerebrospinal The protective body fluid present in the dura, the membrane covering the brain and spinal cord fluid or CSF Decompression A procedure to remove pressure on a structure. Diskectomy, Surgical removal of all or a part of an intervertebral disc. discectomy Dura Outermost of the three layers that surround the brain and spinal cord. Electrode array Device that contains multiple plates or electrodes. Electronic pulse A device that produces low voltage electrical pulses, with a regular or intermittent waveform, that creates a mild tingling or generator or massaging sensation that stimulates the nerve pathways neurostimulator Spine Surgery Terminology & Anatomy Term Definition The space that surrounds the dura, which is the outermost layer of membrane that surrounds the spinal canal. The epidural space houses the Epidural space spinal nerve roots, blood and lymphatic vessels, and fatty tissues . Present inside the skull but outside the dura mater, which is the thick, outermost membrane covering the brain or within the spine but outside Extradural the dural sac enclosing the spinal cord, nerve roots and spinal fluid.
    [Show full text]
  • Analysis of the Cervical Spine Alignment Following Laminoplasty and Laminectomy
    Spinal Cord (1999) 37, 20± 24 ã 1999 International Medical Society of Paraplegia All rights reserved 1362 ± 4393/99 $12.00 http://www.stockton-press.co.uk/sc Analysis of the cervical spine alignment following laminoplasty and laminectomy Shunji Matsunaga1, Takashi Sakou1 and Kenji Nakanisi2 1Department of Orthopaedic Surgery, Faculty of Medicine, Kagoshima University; 2Department of Mechanical Engineering, Faculty of Engineering, Kagoshima University, Sakuragaoka, Kagoshima, Japan Very little detailed biomechanical examination of the alignment of the cervical spine following laminoplasty has been reported. We performed a comparative study regarding the buckling- type alignment that follows laminoplasty and laminectomy to know the mechanical changes in the alignment of the cervical spine. Lateral images of plain roentgenograms of the cervical spine were put into a computer and examined using a program we developed for analysis of the buckling-type alignment. Sixty-four patients who underwent laminoplasty and 37 patients who underwent laminectomy were reviewed retrospectively. The subjects comprised patients with cervical spondylotic myelopathy (CSM) and those with ossi®cation of the posterior longitudinal ligament (OPLL). The postoperative observation period was 6 years and 7 months on average after laminectomy, and 5 years and 6 months on average following laminoplasty. Development of the buckling-type alignment was found in 33% of patients following laminectomy and only 6% after laminoplasty. Development of buckling-type alignment following laminoplasty appeared markedly less than following laminectomy in both CSM and OPLL patients. These results favor laminoplasty over laminectomy from the aspect of mechanics. Keywords: laminoplasty; laminectomy; buckling; kyphosis; swan-neck deformity Introduction In 1930, Eiselberg1 reported a case of postoperative of postoperative abnormal alignment from the aspect kyphosis of the spine following laminectomy from the of the presence or absence of buckling-type alignment.
    [Show full text]
  • Spinal Deformity Study Group
    Spinal Deformity Study Group Editors in Chief Radiographic Michael F. O’Brien, MD Timothy R. Kuklo, MD Kathy M. Blanke, RN Measurement Lawrence G. Lenke, MD Manual B T2 T5 T2–T12 CSVL T5–T12 +X° -X +X° C7PL T12 L2 A S1 ©2008 Medtronic Sofamor Danek USA, Inc. – 0 + Radiographic Measurement Manual Editors in Chief Michael F. O’Brien, MD Timothy R. Kuklo, MD Kathy M. Blanke, RN Lawrence G. Lenke, MD Section Editors Keith H. Bridwell, MD Kathy M. Blanke, RN Christopher L. Hamill, MD William C. Horton, MD Timothy R. Kuklo, MD Hubert B. Labelle, MD Lawrence G. Lenke, MD Michael F. O’Brien, MD David W. Polly Jr, MD B. Stephens Richards III, MD Pierre Roussouly, MD James O. Sanders, MD ©2008 Medtronic Sofamor Danek USA, Inc. Acknowledgements Radiographic Measurement Manual The radiographic measurement manual has been developed to present standardized techniques for radiographic measurement. In addition, this manual will serve as a complimentary guide for the Spinal Deformity Study Group’s radiographic measurement software. Special thanks to the following members of the Spinal Deformity Study Group in the development of this manual. Sigurd Berven, MD Hubert B. Labelle, MD Randal Betz, MD Lawrence G. Lenke, MD Fabien D. Bitan, MD Thomas G. Lowe, MD John T. Braun, MD John P. Lubicky, MD Keith H. Bridwell, MD Steven M. Mardjetko, MD Courtney W. Brown, MD Richard E. McCarthy, MD Daniel H. Chopin, MD Andrew A. Merola, MD Edgar G. Dawson, MD Michael Neuwirth, MD Christopher DeWald, MD Peter O. Newton, MD Mohammad Diab, MD Michael F.
    [Show full text]
  • Lumbar Laminectomy
    Patient Education Lumbar Laminectomy Description The spine consists of five separate divisions: cervical (seven vertebrae), thoracic (12 vertebrae), lumbar (five vertebrae), the sacrum, and the coccyx. Each vertebra, interlocks with the segment above and below it through the superior and inferior articular processes. Between each vertebra is an intervertebral disc that provides cushioning for the spine. The lamina and pedicle, along with the vertebral body, provide the borders that create the spinal canal, which the spinal cord runs through to transmit nerve signals. There are several different scenarios or conditions that may produce symptoms that would lead your physician to further Medical Illustration © 2016 Nucleus Medical Art, Inc. investigate, and possibly recommend this surgery. Stenosis causing Radicular Pain Spinal stenosis is the narrowing of the articular spaces within the spine; this may impinge on the nerves or the spinal cord. This is a degenerative process and may eventually lead to further changes on the spine over time. Radicular symptoms are pain, numbness, weakness, tingling, etc., that radiate along a specific nerve root (or dermatome) to other parts of the body outside of the spine. Surgical correction of this problem may include a minimally invasive decompression (shaving bone away to create more space around the nerve), often referred to as laminectomy (removing part or all of the lamina in order to provide more space and relieve impingement). In some cases, movement of one vertebrae slipping against another (spondylolisthesis), may require a vertebral fusion. This may be performed open vs. minimally invasive. Disc Herniation Herniation of the intervertebral disc may be due to an acute traumatic incident.
    [Show full text]
  • Modern Advances in Joint Replacement and Rapid Recovery
    Modern Advances in Joint Replacement and Rapid Recovery UCSF Osher Mini-Med School Lecture Series Jeffrey Barry, M.D. Assistant Professor of Orthopaedic Surgery Division of Adult Reconstruction University of California, San Francisco Disclosures . No relevant disclosures to this talk About Me . Bay Area Native . UCSF - U Can Stay Forever Outline . Burden of Disease and Epidemiology . The Basics of Hip and Knee Replacement . What’s improving over the last decade - Longevity - Pain Management - Hospital Stay - Thromboembolism prophylaxis - Risk Reduction Question What is the most common inpatient surgery performed in the US? 1. Percutaneous coronary angioplasty 2. Total hip replacement 3. Lumbar Laminectomy 4. Appendectomy 5. Total knee replacement Burden of Disease . Arthritis = most common cause of disability in the US . 22.7% of adults have doctor-diagnosed arthritis - 43.2% of patients with arthritis report activity limitations due to disease . By 2030: - 3.5 million TKA (673%) - 570,000 THA (174%) . Curve updated 2014 – just as predicted! Causes of Increased Utilization . Aging Population . Patients receiving arthroplasty at a younger age - Improvements in technology - Obesity Why Replace a Joint? Arthritis arthro – joint itis – inflammation What is Arthritis – Disease of Cartilage . Cartilage Degeneration - Pain - Limp - Swelling - Loss of range of motion - Eventual deformity Arthritis Affects on Your Life • Quality of Life • Independence • Movement, Walking, Exercise • Self-image • Self-esteem • Family Life • Sleep • Everything and Everybody Causes of Arthritis . Osteoarthritis - “wear and tear” . Inflammatory arthritis . Trauma, old fractures . Infection . Osteonecrosis - “lack of oxygen to the bone” . Childhood/ developmental disease Diagnosis . Clinical Symptoms + Radiographic . Radiographs – Standing or Weight bearing! . MRI is RARELY needed!!! - Expensive - Brings in other issues - Unnecessary treatment - Unnecessary explanations Knee Arthritis .
    [Show full text]
  • Sciatica and Chronic Pain
    Sciatica and Chronic Pain Past, Present and Future Robert W. Baloh 123 Sciatica and Chronic Pain Robert W. Baloh Sciatica and Chronic Pain Past, Present and Future Robert W. Baloh, MD Department of Neurology University of California, Los Angeles Los Angeles, CA, USA ISBN 978-3-319-93903-2 ISBN 978-3-319-93904-9 (eBook) https://doi.org/10.1007/978-3-319-93904-9 Library of Congress Control Number: 2018952076 © Springer International Publishing AG, part of Springer Nature 2019 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
    [Show full text]
  • Cerebral Palsy with Dislocated Hip and Scoliosis: What to Deal with First?
    Current Concepts Review Cerebral palsy with dislocated hip and scoliosis: what to deal with first? Ilkka J. Helenius1 Cite this article: Helenius IJ, Viehweger E, Castelein RM. Cer- Elke Viehweger2 ebral palsy with dislocated hip and scoliosis: what to deal Rene M. Castelein3 with first?J Child Orthop 2020;14: 24-29. DOI: 10.1302/1863- 2548.14.190099 Abstract Keywords: cerebral palsy; hip dislocation; neuromuscular Purpose Hip dislocation and scoliosis are common in children scoliosis; CP surveillance; hip reconstruction; spinal fusion with cerebral palsy (CP). Hip dislocation develops in 15% and surgery 20% of children with CP, mainly between three and six years of age and especially in the spastic and dyskinetic subtypes. The risk of scoliosis increases with age and increasing disabili- Introduction ty as expressed by the Gross Motor Function Score. Hip dislocation develops in 15% and 20% of children with Methods A hip surveillance programme and early surgical cerebral palsy (CP), mainly between three and six years 1 treatment have been shown to reduce the hip dislocation, of age, and especially in the spastic dyskinetic subtypes. but it remains unclear if a similar programme could reduce Children with Gross Motor Function Classification System the need for neuromuscular scoliosis. When hip dislocation (GMFCS) level V demonstrate an incidence of hip dis- 2 and neuromuscular scoliosis are co-existent, there appears to placement up to 90%. The risk of scoliosis increases with 3 be no clear guidelines as to which of these deformities should age and increasing disability (increasing GMFCS level). be addressed first: hip or spine. The risk of scoliosis is 1% for GMFCS level I at ten years of age and 5% at 20 years, but 30% for GMFCS V at ten Results Hip dislocation or windswept deformity may cause years and 80% at 20 years.
    [Show full text]
  • Spondylolysis and Spondylolisthesis in Children and Adolescents: I
    Spondylolysis and Spondylolisthesis in Children and Adolescents: I. Diagnosis, Natural History, and Nonsurgical Management Ralph Cavalier, MD Abstract Martin J. Herman, MD Spondylolysis and spondylolisthesis are often diagnosed in children Emilie V. Cheung, MD presenting with low back pain. Spondylolysis refers to a defect of Peter D. Pizzutillo, MD the vertebral pars interarticularis. Spondylolisthesis is the forward translation of one vertebral segment over the one beneath it. Isth- Dr. Cavalier is Attending Orthopaedic mic spondylolysis, isthmic spondylolisthesis, and stress reactions Surgeon, Summit Sports Medicine and involving the pars interarticularis are the most common forms seen Orthopaedic Surgery, Brunswick, GA. Dr. Herman is Associate Professor, in children. Typical presentation is characterized by a history of Department of Orthopaedic Surgery, activity-related low back pain and the presence of painful spinal Drexel University College of Medicine, mobility and hamstring tightness without radiculopathy. Plain ra- St. Christopher’s Hospital for Children, Philadelphia, PA. Dr. Cheung is Fellow, diography, computed tomography, and single-photon emission Department of Orthopaedic Surgery, computed tomography are useful for establishing the diagnosis. Mayo Clinic, Rochester, MN. Dr. Symptomatic stress reactions of the pars interarticularis or adjacent Pizzutillo is Professor, Department of vertebral structures are best treated with immobilization of the Orthopaedic Surgery, Drexel University College of Medicine, St. Christopher’s spine and activity restriction. Spondylolysis often responds to brief Hospital for Children. periods of activity restriction, immobilization, and physiotherapy. None of the following authors or the Low-grade spondylolisthesis (≤50% translation) is treated similarly. departments with which they are The less common dysplastic spondylolisthesis with intact posterior affiliated has received anything of value elements requires greater caution.
    [Show full text]
  • Spondylolisthesis, with Description of a Case
    [Reprinted from the Transactions of the American Orthopedic Association, 1897.] SPONDYLOLISTHESIS, WITH DESCRIPTION OP A CASE. ROBERT W. LOVETT, M.D., BOSTON. The name spondylolisthesis (ottovoo/loc, a vertebra, and bhadrjat c, a gliding) refers to a forward subluxation of the body of one of the lower lumbar vertebrae, with the exception of one recorded case where the upper part of the sacrum was displaced forward. This displacement has ordinarily been described as a dislocation ; in most instances it hardly reaches a greater degree than may be described by the name subluxation. Even this name is incorrect anatomic- ally. This is because the body of the vertebra is chiefly affected, while the laminae and spinous process remain practically in place. The condition has attracted attention chiefly from the obstetrical point of view, on account of the secondary pelvic changes produced, and surgical literature contains next to nothing about it. Fr. Neugebauer, 1 of Warsaw, has so thoroughly investigated and elab- orated the subject that whoever strives to elucidate it from any point of view must do so largely by quotations from his extensive writings. In 1854, when this condition was recognized and named by Killian, 2 there were described only four known anatomical speci- mens. In 1890, when Neugebauer’s treatise was written, there were one hundred and one clinical and anatomical observations. Blake, 3 Gibuey, 4 and Lombard 5 contributed the only recorded American observations. Between the publication of Neugebauer’s classic in 1892, which was written in 1890, and to-day there have been reported, so far as I could find, twenty-four more cases (two in men).
    [Show full text]
  • Failure to Maintain Segmental Lordosis During TLIF for One-Level
    European Spine Journal (2019) 28:745–750 https://doi.org/10.1007/s00586-019-05890-w ORIGINAL ARTICLE Failure to maintain segmental lordosis during TLIF for one‑level degenerative spondylolisthesis negatively afects clinical outcome 5 years postoperatively: a prospective cohort of 57 patients Matevž Kuhta1 · Klemen Bošnjak2 · Rok Vengust2 Received: 14 June 2018 / Revised: 28 November 2018 / Accepted: 13 January 2019 / Published online: 24 January 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Purpose The present study aimed to determine whether obtaining adequate lumbar (LL) or segmental (SL) lordosis during instrumented TLIF for one-level degenerative spondylolisthesis afects midterm clinical outcome. Methods The study was designed as a prospective one, including 57 patients who underwent single-level TLIF surgery for degenerative spondylolisthesis. Patients were analyzed globally with additional subgroup analysis according to pelvic incidence (PI). Radiographic analysis of spinopelvic sagittal parameters was conducted pre- and postoperatively. Clinical examination including ODI score was performed preoperatively, 1 and 5 years postoperatively. Results Signifcant improvement in ODI scores at 1 and 5 years postoperatively (p < 0.001) was demonstrated. There was a signifcant correlation between anterior shift of SVA and failure to improve SL (p = 0.046). Moreover, anterior SVA shift correlated with increased values of ODI score both 1 and 5 years postoperatively. In low-PI group, failure to correct LL correlated with high ODI scores 5 years postoperatively (r = − 0.499, p = 0.005). Conclusions Failure to correct segmental lordosis during surgery for one-level degenerative spondylolisthesis resulted in anterior displacement of the center of gravity, which in turn correlated with unfavorable clinical outcome 1 and 5 years postoperatively.
    [Show full text]