Spondylolisthesis is a condition where one of the vertebrae (usually L5) becomes misaligned anteriorly (slips forward) in relation to the vertebra below. This forward is caused by a problem or defect within the pars interarticularis. Occasionally, facet joint and/or posterior neural arch defects may also cause this syndrome as well. The forward slippage does NOT always occur; however, the par defect, which is considered a non-united childhood fracture still may be present. This non-slipped pars defect is called a "Spondylolysis" and is almost always a precursor to the actual forward slippage.The structures - pars interarticularis, facets, neural arch are responsible for holding the anterior portion of the vertebrae (vertebral body) in perfect alignment. Maintaining this alignment is critical in order to keep the spinal exit-holes, (aka: neuroforamen), which are where the delicate spinal nerves exit the spine, large and open. Any narrowing of the neuroforamen may result in compression of the ultra-sensitive exiting spinal nerve root and dorsal root ganglia that in turn may well result in back pain.
The pars interarticularis, is the weakest and thinnest region of the lumbar vertebra.
Thanks, doctor, for the information about spondylolisthesis. What's your experience treating spondylolisthesis with manipulation/adjustments? It's tricky, isn't it? There are patients who report their symptoms worsening after an adjustment.
ReplyDeleteSorry for the slow reply, I had a few family issues this winter but I am back. The answer is yes to both.
DeleteThey do and can get worse that is why I always get an A/P and Lat view of any patient with a chronic low back condition. The most important thing is to keep the L-5 S-1 in flexion while adjusting. I have a Thompson drop table that allows me to crank it up to about 10 to 20 degrees of flexion and then do a VERY gentle inferior P to A adjustment. and then get them up and on a therapy table with ICE and E-stim of some type Micro is what I use, keep the patients knees elevated with a large bolster for 20 minutes. good luck. Thanks for following my blog, Dave Thomson DC