Isthmic spondylolisthesis: chiropractor viewpoint
Chief complaint
Intermittent right lower extremity radiating
pain exacerbated through walking 100 feet, standing
extension and relieved with sitting/forward flexion.
Exam and imaging studies
Mild weakness in extending the right first
digit. No signs of neural tension during SLR,
and hip mobility is adequate. Plain film radiography
and MRI scans show isthmic spondylolisthesis
at L5-S1. Early degenerative disc disease with
disc bulge and right foraminal stenosis at L4-L5
impinging the L5 nerve root.
Chiropractic treatment plan
Chiropractic management may begin with further
radiographic studies. Flexion/extension and axial
traction/compression radiographs will provide
useful information on the stability of the L4-L5-S1
segments. If there is no evidence of instability,
more aggressive chiropractic techniques can be
utilized, including side posture manipulation.
Since a large majority of patients with spondylolisthesis
have an associated hyperlordosis, facet syndrome
and/or sacroiliac fixation, these conditions
are often the cause of lower back pain rather
than the spondylolisthesis. Specific chiropractic
manipulation of the sacroiliac joints and the
lumbar zygapophyseal joints (facet joints) above
the segment with the pars defects can provide
relief of pain often associated with this condition.
Chiropractic manipulation of these joints may
improve the biomechanical mobility of overloaded
segments and thus reduce stress at the L5-S1
joint complex.
Flexion Distraction Chiropractic Manipulation
may be used as treatment for the disc bulge and
foraminal stenosis at L4-L5. This is a low force
technique that helps improve mobility of the
vertebral segments, flexibility of the annular
fibers of the disc, mobility of the L5 nerve
root within the IVF, decreasing the symptoms
of stenosis.
A specific rehabilitation program should be
developed for the patient. This program should
address findings from the functional exam and
improve deficits in flexibility, motor control
and pain provoking movements.
By:
Rodney K. Lefler, DC
October 10, 2000 |
