Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J

Clinical Epidemiology Research and Training Unit, Boston University, 650 Albany Street (X Building), Suite 200, Boston, MA 02118, USA.
European Spine Journal (Impact Factor: 2.07). 04/2008; 17(3):327-35. DOI: 10.1007/s00586-007-0543-3
Source: PubMed


Degenerative spondylolisthesis (DS) is a disorder that causes the slip of one vertebral body over the one below due to degenerative changes in the spine. Lumbar DS is a major cause of spinal canal stenosis and is often related to low back and leg pain. We reviewed the symptoms, prognosis and conservative treatments for symptoms associated with DS. PubMed and MEDLINE databases (1950-2007) were searched for the key words "spondylolisthesis", "pseudospondylolisthesis", "degenerative spondylolisthesis", "spinal stenosis", "lumbar spine", "antherolisthesis", "posterolisthesis", "low back pain", and "lumbar instability". All relevant articles in English were reviewed. Pertinent secondary references were also retrieved. The prognosis of patients with DS is favorable, however, those who suffer from neurological symptoms such as intermittent claudication or vesicorectal disorder, will most probably experience neurological deterioration if they are not operated upon. Nonoperative treatment should be the initial course of action in most cases of DS, with or without neurologic symptoms. Treatment options include use of analgesics and NSAIDs to control pain; epidural steroid injections, and physical methods such as bracing and flexion strengthening exercises. An up-to-date knowledge on diagnosis and prevention of lumbar DS can assist in determination of future research goals. Additional studies are required to establish treatment protocols for the conservative treatment of DS.

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    • "Campbell et al. [17] reported that canal diameter is not predictive of response to epidural steroid injection in patients with lumbar canal stenosis. Ng et al. [27] reported no effect of corticoids in a study of patients with lumbar canal stenosis that compared anesthetics plus epidural corticoids with anesthetics alone. While these results are in general agreement with ours, Sayegh et al. [28] report clinical improvement with epidural corticoids. "
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    ABSTRACT: Background Corticoids have potent anti-inflammatory effects, which may help in relieving pain and dysfunction associated with lumbar canal stenosis. We assessed the effectiveness of a decreasing-dose regimen of oral corticoids in the treatment of lumbar canal stenosis in a prospective, double-blind, randomized, placebo-controlled trial. Results Sixty-one patients with lumbar canal stenosis (50–75 years; canal area < 100 mm2 at L3/L4, L4/L5, and/or L5/S1on magnetic resonance imaging; and claudication within 100 m were electronically randomized to an oral corticoid group (n = 31) or a placebo group (n = 30). The treatment group received 1 mg/kg of oral corticoids daily, with a dose reduction of one-third per week for 3 weeks. Patients and controls were assessed by the Short Form 36 Health Survey, Roland–Morris Questionnaire, 6-min walk test, visual analog scale, and a Likert scale. All instruments showed similar outcomes for the corticoid and placebo groups (P > 0.05). Obese patients exhibited more severe symptoms compared with non-obese patients. L4/L5 stenosis was associated with more severe symptoms compared with stenosis at other levels. Conclusion The oral corticoid regimen used in this study was not effective in the treatment of lumbar canal stenosis.
    Full-text · Article · Aug 2014 · Journal of Negative Results in BioMedicine
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    • "The pathology and clinical presentation of DLS patients are different from the other degenerative changes of the lumbar spine. The pathology of DLS is overall problems of disc degeneration, facets arthrosis, central and lateral spinal canal stenosis with instability of ligaments and muscles [10,11]. "
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    ABSTRACT: A prospective cohort. To report the short and long term outcomes of fluoroscopically guided lumbar transforaminal epidural steroid injection (TFESI) in degenerative lumbar spondylolisthesis (DLS) patients. TFESI has been widely used for the treatment of lumbosacral radicular pains. However, to our knowledge, there has been no study which has evaluated the outcomes of TFESI in patients with DLS. The DLS patients received fluoroscopically guided lumbar TFESI with 80 mg of methylprednisolone and 2 mL of 1% lidocaine hydrochloride. Patients were evaluated by an independent observer before the initial injection, at 2 weeks, at 6 weeks, at 3 months, and at 12 months after the injections. Visual analog scale (VAS), Roland 5-point pain scale, standing tolerance, walking tolerance, and patient satisfaction scale were evaluated for outcomes. Thirty three DLS patients treated with TFESI, who were completely followed up, were included in this study. The average number of injections per patient was 1.9 (range from 1 to 3 injections per patient). Significant improvements in VAS and Roland 5-point pain scale were observed over the follow up period from 2 weeks to 12 months. However, the standing and walking tolerance were not significantly improved after 2 weeks. At 2 weeks, the patient satisfaction scale was highest, although, these outcomes declined with time. The DLS patients with one level of spinal stenosis showed significantly better outcome than the DLS patients with two levels of spinal stenosis. Five patients (13%) underwent surgical treatment during the 3 to 12 months follow up. TFESI provides short term improvements in VAS and Roland 5-point pain scale, standing tolerance, walking tolerance and patient satisfaction scale in DLS patients. In the long term, it improves VAS but limits the improvements in Roland 5-point pain scale, standing tolerance, walking tolerance and patient satisfaction scale.
    Full-text · Article · Apr 2014 · Asian spine journal
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    • "Other injections commonly performed include localized treatment at the pars defect or facet joints and selective nerve root blocks (Agabegi & Fischgrund, 2010; Kalichman et al., 2009). Surgical treatments are suggested after 6 months of failed conservative treatment in cases with radiculopathy or neurogenic claudication, progressive neurological deficits, progressive or high-grade slips, or bladder and bowel symptoms (Agabegi & Fischgrund, 2010; Kalichman & Hunter, 2008; Tsirikos & Garrido, 2010). "
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    ABSTRACT: To provide nurse practitioners (NPs) with an overview of spondylolysis and spondylolisthesis, including the pathophysiology and etiology, incidence and prevalence, clinical presentation, diagnosis and differentials, management, and prognosis for these conditions. Selected research, reviews, and clinical articles, and the authors' experience. Spondylolysis and spondylolisthesis are two common and confusing diagnoses identified by healthcare providers in the treatment of low back pain. Symptoms can vary depending on the degree of disarticulation with radiculopathy occurring in advanced grades of spondylolisthesis. Standing, lateral lumbosacral radiographs remain the gold standard for diagnosis. The majority of patients will improve with conservative treatments. Surgical options are warranted after 6 months of failed conservative treatments for patients with radiculopathy, neurogenic claudication, progressive neurological deficits, high-grade slips, or bladder and bowel symptoms. NPs can distinguish these diagnoses and perform appropriate conservative management prior to referral to specialists for surgical evaluation. NPs are important providers in interdisciplinary care by assisting patients with both psychosocial and physical management of their back pain.
    Preview · Article · Jan 2014 · Journal of the American Association of Nurse Practitioners
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