Back Pain

Lower Back Pain:
Acute Low Back Pain, Chronic Low Back Pain, Slipped Disc, Sciatica, Disc herniation, muscle strain, facet joint strain, spondylolisthesis, scoliosis,


What is a spondylolisthesis?
Spondylolisthesis can cause back pain.   The most common spondylolisthesis is an anterolisthesis. This is when one vertebra slips forward on the vertebra below. This is most common at the fifth lumbar vertebra when it slips forward on the first sacral segment.

Grading of spondylolisthesis
Anterolisthesis is graded as 1-4, a grade 1 anterolisthesis is when there has been a slippage of 25% forward, a grade 2 is a slippage of 50% etc.

A retrolisthesis is less common, this is when the vertebra slips backwards on the vertebra below.

Types of spondylolisthesis
Type 1:  dysplastic spondylolisthesis occurs secondary to a defect with the facet joints at L5S1 resulting in gradual forward slipping of the vertebra.

Type 2:  this occurs when there is a defect in the pars interarticularis. Slippage of the vertebra may occur. If there is slippage it is called an isthmic spondylolisthesis. If there is no slippage and if there is just the pars defect it is known as spondylolysis.
This type of spondylolisthesis is most associated with hyperextension injuries and micro stress fractures of the pars.

Type 3:  this spondylolisthesis is not associated with a pars defect but with degeneration of the lumbar facet joints and is common in the elderly but doesn  t result in more than a 30% slippage.

Type 4:  this is a traumatic spondylolisthesis and occurs when there is fracture to the posterior elements of the vertebral body.

Type 5:  this is a pathological spondylolisthesis and is associated with a tumour or other disease process causing weakness to the posterior elements.

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What causes a spondylolisthesis?
• Hyperextension injuries such as in gymnasts
• Tumours or pathology
• Degenerative changes
• Traumatic
• Congenital

Signs and symptoms of spondylolisthesis
There are often very few symptoms of a grade 1 spondylolisthesis other than a bit of back pain and nothing more than in the rest of the population. As the percentage of slippage of the spondylolisthesis increases so the symptoms may increase. Low back pain may increase and there may be pain into the buttocks and legs. There may also be increased muscle spasm in the lumbar spine and in the buttocks and tight hamstrings.

The symptoms may be activity related and on cessation of activity symptoms of low back pain and muscle spasm may go away.

Upper Back Pain and Neck Pain
Muscle spasm, acute wry neck, cervical disc, muscular instability, articular dysfunction, upper trapezius trigger points, whiplash, cervical postural syndromes, headaches, scheuermanns disease

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