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Test 2 - Nrad
Spondylolisthesis
Question | Answer |
---|---|
***What is defined as the anterior displacement of a vertebral body in relationship to the segment immediately below? | Spondylolisthesis (aka Anterolisthesis) |
***What is defined as an interruption of the pars? | Spondylolysis |
***What is defined as posterior displacement of the vertebral body relative to the segment below? | Retrolisthesis |
***What is the most common stress fracture in the body? | Pars fracture (spondylolysis) |
***What is defined as anterior slippage of L5, where it is actually anterior and inferior to the sacral promontory? | Spondyloptosis |
In what type of individuals are incidences of spondylolysis seen most often? | Athletes (diving, gymnsts, weightlifters, pole vaulting - all require repetitive hyperextension). High incidence in Alaskan Eskimo pop (up to 40%) and Native American pops. |
***What is the most common location for spondylolisthesis and/or spondylolysis? | L5 - 90%, L4 - 5% |
FACT: There are 5 WILTSE Classification types of Spondylolisthesis: | 1 - Dysplastic 2 - Isthmic 3 - Degenerative 4 - Traumatic 5 - Pathological |
What classification type of spondylolisthesis has a pars fracture? | type 2 - Isthmic |
T/F Type 3 - Degenerative Spondylolisthesis has a pars fracture and is most common at L5. | False - There is NO pars fracture and it is 10X more commonly seen at L4 level |
T/F If you see a vaccum phenomenon (gas density) in a disc that is a sign of disc degeneration? | true |
***What classification of spondylolisthesis is most common at C2 and is referred as a Hangman's Fracture? | Type 4 - Traumatic |
What classification of spondylolisthesis is associated with Paget's disease, metastatic bone disease, and osteopetrosis? | Type 5 - Pathological |
T/F Approx. 50% of patients with spondylolisthesis and/or spondylolysis NEVER develop back pain? | true, those that do experience back pain usually have a seperate biomechanical or pathological cause |
Clincally, if a patient comes into your office and you hear a clicking sound during straight leg raise "spinal rattle" and the have a short strided gait, what could they have? | Spondylolisthesis |
Should you discourage an athlete to stop activities if they have a chronic process of spondylolisthesis? | NO not for chronic procss, advise them to stop activity if they have Acute process of spondylolisthesis |
At what age is progression of spondylolisthesis most common? | 5 - 10 yoa, it is very uncommon past 18 yoa |
***Radiographically what is it called when an advanced grade of 3, 4, or 5 spondylolisthesis is seen on a AP projection at L5? | bowline of Brailford (aka: inverted Napolean's hat sign, or Gendarme's cap) |
***What is Meyerdin'g Method? | It is a line of mensuration to test for anterior displacement m/c at L5/S1. (It divides the Sacral Base into 4 quadrants). |
What are the grades for Meyerding's Method? | Grade 1 - 0-25% ant displacement 2. 25-50% ant displacement 3.51-75% ant dis 4.76-100% ant dis ***Grade 5 = SPONDYLOPTOSIS |
What is the name for an anterior spondylophyte (osteophyte) formation at anterior aspect of sacral base and is an attempt to stabilize? | Buttressing phenomenom |
What type of radiographic view is used to see a defect in the pars? | Oblique Lumbars, so you can see the broken neck of the little Scotty Dog |
What is it called when there is a unilateral pars defect and contralateral sclerosing of the pedicle? | Wilkinson Syndrome - this is the m/c cause of a sclerotic pedicle |
T/F If you see a sclerotic pedicle on one side and a pars fracture on the other side its probably NOT metastatic disease? | true |
Normal Pedicle + Sclerotic Pedicle = | Be concerned, (if there is a sclerotic pedicle and no pedicle on the other side, this is usually ok) |
T/F Spondylolisthsis in the cervical spine are uncommon? | true, if present m/c at C6 |
T/F In the cervical spine pars defects are m/c unilateral and approx. 50% are associated with SBO of a vertebrae? | false, pars are m/c bilaterally but 50% are associated with a SBO |
***Where is Spondylolytic Spondylolisthesis most commonly seen? | L5 |
***Where is Degenerative spondylolisthesis most commonly seen? | L4 |
Since it Is uncommon to see children with back pain, if one comes in your office with back pain what could this be a sign of? | Pars Defect |
If there is a greater of _____ mm of total translation in flexion and extension in a spondylolisthetic segment, it may be considered unstable? | greater than 4mm in translation = unstable |
How should you advise someone with spondylolysis to help treat their problem? | Spondylolysis means - stop causative activity 6-8 wks, bed rest, stretching hamstrings and strengthing abdominal and back mm. Boston brace may help (this is different than spondylolisthesis when it depended if it was chronic or actue) |