1) Spinal fusion (for spondylolisthesis)

Spondylolisthesis has been classified into grades I, II, III, IV and V depending on the severity of the displacement of the vertebra above on the vertebra below. In severe cases involving the lumbar spine, cauda equina syndrome can occur.

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Smoking significantly decreases the chance for a successful fusion. Some surgeons prefer that a patient commit to smoking cessation up to one month before the surgical procedure.

The level of the Spondylolysis/Spondylolisthesis must be identified.

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The clinical presentation differs, depending on the type of slip and the age of the patient.

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The facet joints, also known as zygapophysial joints are synovial joints which help support the weight and control movement between individual vertebrae of the spine.

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Patients with lumbar disk disease canpresent with back pain or a radicular painsyndrome. The classic sciatic syndrome consists of stiffness in the back and pain radiating down tothe thighs, calves and feet, associated with paresthesias, weakness, and reflex changes. The pain fromintervertebral disk disease is exacerbated by coughing, sneezing, or physical activity. Pain is usuallyworse when sitting, and with straightening or elevating the leg. Disk herniations occur most oftenat the lower lumbar levels - 90% at L4-5 and L5-S1, 7% at L3-4, and remaining 3% at the upper 2levels.

- a bulging disk that is eccentric toone side but

Although the use of spinal instrumentation in skeletally immature patients is considered optional by some surgeons for some patients with isthmic-type spondylolisthesis, most spinal surgeons believe that rigid fixation is needed to achieve a solid fusion reliably. For degenerative-type slips, fixation has been shown to achieve higher rates of solid arthrodesis.

Indications for surgical intervention (fusion) are as follows:

The most common symptom of this condition is stiffness in the back and pelvis. The pain is usually more severe after you have been at rest for some time, such as upon first waking. It generally gets better with movement, but as the condition progresses, it can stiffen your spine to the point of immobility.

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As a consequence of intervertebral disk degeneration, normal axial loading on the spine stretchesand lengthens the anular fibers, resulting in rounded, symmetric bulging of the disk beyond themargins of the vertebral body. A bulging disk encroaches on the ventral spinal canal and inferiorportions of the neuroforamina but does not displace or impinge the nerve roots. The combination ofsagittal and axial views provides excellent visualization of the relationships of the disk to the spinalcanal and neural foramina. When there is a generalized paucity of epidural fat, producing an MR"myelogram" with gradient-echo or T2-weighted images is helpful to show the relationship of the diskwith the thecal sac.

We treat more than 600 patients with spondylolisthesis each year.

One of the earliest signs of disk degeneration is loss of water content or desiccation, mostnoticeable in the nucleus pulposus. MR can detect early disk degeneration because, as the disks losewater, the MR signal decreases on gradient-echo and T2-weighted images. With more advanceddegeneration, the disk collapses and gas may form within the disk. Calcification is not uncommonin chronic degenerative disk disease.