Cervical Spondylolisthesis - Neck Pain

As the spine degenerates with age, arthritis and spondylolisthesis are fairly common problems. Fortunately this does not uniformly result in disabling pain. For those patients that do have pain, a proper course of non-operative treatment can be very successful. For those who have failed this, fusion can be very successful in the right patient.

Spondylolisthesis of the Neck: Causes, Treatments, …

The surgery for treatment of anterolisthesis is referred to as interbody fusion

Grade 1 degenerative anterolisthesis - Things You …

Debilitating pain - spondylysis - spondylolithesis 1. Pars fusion - painful spondylysis - minimal spondylolithesis 2. Fusion A. In situ v reduction - not required for grade 1 - 2 - consider if sagittal malalignment - associated with risk neurology especially L5 - controversial if should be performed in high grade slips B. Instrumented / non instrumented C. Levels - L5/S1 if grade I or II / 50% or less - L4/S1 if 50% for more D. Interbody cages - useful in long standing spondylolithesis presenting in adulthood - degenerative disc disease - nerve root pain from interforaminal compression - improves nerve root space - improves healing rate E. Posterior v circumferential - circumferential approaches may improve fusion rates and outcome in high grade slips Indication - normal discs and facets - pain relieved by pars injection - failure brace / non operative treatment - minimal slip Technique - lesion identified / debrided / iliac crest bone graft Options ORIF 1. Screw across lytic defect - unilateral defect 2. Pedicle screw + laminar hook - bilateral defect 3. TBW spinous process and transverse process Results Kakluchi et al JBJS Am 1997 - 16 patients with failure non operative treatment bilateral pars defect - pain relieved by pars injection with LA - pedicle screw + lamina hook - nerve root decompression where required - union in all 16 - 3 patients only had occasional back pain A. Wiltse Lateral Mass Fusion in situ Concept - in situ fusion via a paraspinal muscle splitting approach - no reduction or instrumentation Indication - for L5/S1 with minor slip in young patient - rarely done these days - most surgeons perform instrumented fusion Technique - midline incision - two paramedian incisions in lumbodorsal fascia 4.5cm lateral to midline - paraspinous muscle splitting approach 2 fingerbreadths lateral to midline - split sacrospinalis using finger to dissect through muscle - don't go anterior to TP or risk damage to nerve root - decorticate TP / Sacral ala / facet / famina and add crest graft / allograft / BMP Post-op - spica 3/12 with 1 leg incorporated - activity modification for 6/12 Instrumented fusion in situ without reduction Indications - slip grade 1 or II - grade III or IV with no sagittal malalignment Levels instrumentation - L5 / S1 grade I or II - L4 / S1 grade III or IV Options 1. Pedicle screw instrumentation 2. PLIF / interbody cage 3. Bohlman procedure - interbody fusion with fibula strut - augmented with decompression and PLF 4.

Grade 1 degenerative anterolisthesis ..

lordosis) Minimal symptoms Low risk progression - isthmic - mild slip (Meyerding I / II, slip angle o) Observation until mature - review annually to ensure no progression of slip Consists of - activity modification - cease aggravating symptoms - NSAIDS - hamstring stretches - brace Indication - spondylosis / grade 1 spondylolithesis - acute / hot on bone scan Theory - attempt to heal pars fracture - healing is not required for symptoms to settle Type - anti-lordotic - 3/12 full time, no sport - 3/12 full time with sport Results Debnath et al Spine 2007 - 42 patients with unilateral spondylysis hot on SPECT - 6/12 non operative treatment including bracing - 81% avoided surgery / complete resolution of symptoms - remainder had CT confirmed non union and underwent unilateral pars fixation 1. High risk slip - slip degree > 50% - slip angle > 30o - dysplastic - skeletally immature 2.

Cervical spondylosis — Comprehensive overview covers symptoms, treatment of neck osteoarthritis.
X-ray of the lateral lumbar spine with a grade III anterolisthesis at the L5-S1 level

How is the interbody fusion surgery carried out

uncovertebral spur Confirm diagnosis - should get some temporary symptomatic relief Indication - concern re peripheral nerve entrapment SNAP - are usually normal because lesion proximal to DRG CMAP - amplitude decreased proportional to muscle atrophy Nerve conduction velocity - not abnormal unless severe demyelination of axons EMG - best for differentiating peripheral nerve root compression from central - fibrillations Rest Pharmaceutical / NSAIDS Physio - hot / cold - electrical stimulation - ROM / stretching - isometric strengthening exercises Cervical traction Collar HCLA / nerve root injections Lellad et al Ann Phys Rehabil Med 2009 - RCT demonstrating benefit of reducing symptoms with cervical traction Kuijper et al BMJ 2009 - RCT demonstrating benefit of wearing semi-hard collar for 3 weeks - severe pain - severe neurological impairment - failure non operative treatment ACDF Disc replacement Corpectomy Laminoforaminotomy

Is there any solution to Grade I anterolisthesis L5 over S1 due to L5 ..

This is basically another term for spondylolisthesis

Non-operative Therapy
Treatment for a degenerative spondylolisthesis is based on the characteristics of the patient’s symptoms. Acute symptoms may sometimes be relieved with 1-2 days of bedrest. In addition, medications such as anti-inflammatories or narcotics can be given to help alleviate some symptoms.

Braces have a minor role in treatment as they can help stabilize the spine. This could be worn for comfort as needed, for a short period of time. Physical therapy is often prescribed to increase back conditioning. Typically when a patient has degenerative spondylolisthesis the muscles in the back have become deconditioned. Muscle strengthening can help by reducing the frequency and intensity of the spasms that occur with degenerative spondylolisthesis. There is also a role for epidural steroid injections to help alleviate any inflammation that may exist.

Learn about cervical spondylolisthesis, which is the slippage of the spine, as well as available treatment options, like minimally invasive spine surgery.

Cervical retrolisthesis treatment - Things You Didn't Know

Operative Therapy
Surgery for degenerative spondylolisthesis is considered absolute only when there is an acute neurologic deficit (significant leg weakness). Typically when there is forward slippage of one vertebra on another there is minimal affect on the nerves. Unfortunately as the slip progresses it can pull on the nerves exiting the spinal canal causing pain, numbness and/or weakness. At this time, consideration should be given to surgery. Otherwise surgery is indicated if the pain continues to progress after all methods of non-operative therapy have been exhausted.

Surgical treatment for degenerative spondylolisthesis requires fusing the slipped vertebrae to the adjacent vertebrae. This will prevent the instability that causes pain. There are many ways that a surgeon can perform a fusion. One method is to take bone from the pelvis (autograft) and place it between the slipped vertebrae. Over time this bone grows in between the two vertebrae and fuses the two bones together, preventing the painful motion. There are reports that have indicated that a fusion is more likely to be successful if instrumentation is added to the procedure. This typically involves placing screws into the pedicles of the spine. The screws are connected by metal rods that hold the adjacent vertebrae together. The screws provide additional support to the spine while the fusion occurs. If spinal stenosis co-exists with the degenerative spondylolisthesis then a decompressive procedure (lumbar laminectomy) may also be performed.