January 3, 2010
Degenerative Lumbar Spondylolisthesis - Newer Concepts
Quite often we have new patients come to our clinic with a diagnosis of “sciatica”. This term has become popular for describing any condition that involves leg pain related to lower back dysfunction. Believe it or not, “sciatica” is not a diagnosis and there are many different conditions that involve symptoms of nerve irritation in the legs. For a treatment to be effective your condition must be diagnosed properly. Has degenerative lumbar spondylolisthesis been considered as a potential diagnosis for your leg symptoms?
Lumbar spondylolisthesis is a condition in which one vertebra “slips” forward on the one below. There are many different types of spondylolisthesis, one of the most common being degenerative. In this type, the slippage is linked to wear and tear in the joints of the lumbar spine. But what has some of the more recent research uncovered about degenerative lumbar spondylolisthesis?
The 4th and 5th lumbar level is the most commonly effected, with the quadratus lumborum muscle and the iliolumbar ligament often playing a role.
The orientation of certain joints in the lumbar spine (called the facet joints) can predispose the lumbar spine to slippage.
Although frequently seen with this condition, disc degeneration is not an important predisposing factor for slippage. In fact, certain progressions of degeneration in other areas of the vertebrae can actually help to stabilize the slippage!
Other risk factors for degenerative spondylolisthesis in the lumbar spine include being older than 50, being female, having previous pregnancies, being African American and having generalized joint laxity.
Effective treatment for degenerative lumbar spondylolisthesis involves maintenance of proper motion in the hips and other areas of the lumbar spine. Ensuring that certain muscles in the lumbar area assist in stabilizing the spine is also important. As previously mentioned, diagnosis is the key to proper care. Call us today; we can accurately diagnose your lower back condition for you and suggest some up to date, evidence based recommendations for treatment and home exercise!
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References
Kalichman L, Hunter D. Degenerative lumbar spondylolisthesis: anatomy, biomechanics and risk factors. Journal of Back and Musculoskeletal Rehabilitation 21 (2008) 1-12.
Sengupta DK, Herkowitz HN. Degenerative spondylolisthesis: review of current trends and controversies. Spine 30 (2005) S71-S81.
Disclaimer
The purpose of this blog is to educate patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Our chiropractic clinic in Burlington, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site. Should you have any further questions about these topics please contact our chiropractic clinic in Burlington.
Mike Hale, D.C.
June 6th, 2010 at 9:39 amMy wife has a severe degenerative spondylo at L4-5. She has had treatment from many different chiro techniques with little success. A friend in Maine that does motion palpation treated her one time and she was pain free for 2 days, even with a long walk which usually causes lots of pain. Unfortunately, it returned on the second treatment. She has had the problem for over 2 years and does not want to have surgery. There are times that it seems to tighten up and there is very little crepitis. Other times the crepitis and movement is severe. A muscle relaxer does help. She has had bracing and facet blocks, but with little help.
Is there anything you do special, besides the core strengthening? She has problems with exercises that cause excessive movement in that area.
Any help would be appreciated.
Mike
Kevin McIntyre DC
June 6th, 2010 at 8:48 pmOur treatment usually depends on the patients specific presentation. Quite often this would include active release technique (ART) and/or graston technique to any dysfunctional soft tissue. Laser might also be used to help improve blood flow and generally improve the celluar composition of the area. In terms of rehabilitation, we would usually advise against an approach that involves repeated flexing and extending the affected level. Instead, we would recommend a lot of static (plank type) strengthening in the lower back and abdomen while trying to minimize shearing of the spine, especially in the affected area.