occurs in an older age group, usually over 60 years old, and it ismore common in women at the level of L4-L5. It develops when there are severe degenerativechanges and excess motion of the facet joints. Subluxation at the facet joints allows forward orposterior movement of one vertebra over another. A degenerative spondylolisthesis narrows thespinal canal, and symptoms of spinal stenosis are common. Hypertrophic facet arthrosis is a frequentcause of foraminal narrowing.
refers to a cleft or break in the pars interarticularis of the vertebra. It is found inabout 6% of adults, mostly in males, 93-95% occur at L5, and most are bilateral. The etiology isuncertain, but the current theory is that it represents a stress fracture from repeated trauma to thespine. The pars defect is demonstrated best in parasagittal images and is easier to see if the bonehas a generous component of marrow or if soft tissue is interposed between the bone fragments. With subluxation, there is often a step-off at the pars defect. On axial views, the key observation isa horizontal line (an extra joint) between adjacent facets joints on consecutive images.
Prior to beginning any injection therapies, I believed he would benefit from such care that would only enhance his response to Prolotherapy. While this treatment was ongoing, I began a course of five neural therapy treatments The area of treatment for neural therapy involved injection of 0.5% procaine without preservative and buffered to a pH of 8.0 to areas identified as interference fields. These are areas of autonomic dysfunction. In this case, I used a form of applied kinesiology known as Autonomic Response Testing to localize the problematic areas and treat. They were areas of previous surgical scars that had a role to play in the patient’s appreciation of pain. If you will, the autonomic component or “nerve” component of the mechanical pain with its foundation in instability. This German technique for balancing the autonomic nervous system is, at times, important to deal with the nervous system component of pain sensation. Once the neural therapy was completed, the addition of appropriate physical therapies primed the patient for success with Prolotherapy. The Prolotherapy solution used was 25% glucose with 1% lidocaine and 0.25% Marcaine® at levels L4, L5 and S1. This was done at monthly intervals, three times, and then again on two occasions five months later. At this point, Freddie no longer had back pain, was able to work and participate in sports and was off all medications! His follow up X-ray report showed no associated retrolisthesis consistent with his absence of back pain! (See Figure 2.) The two X-ray reports were interpreted by two different radiologists.
The posterior braches of L3, L4, L5 and S1 nerves supplying the muscles and skin of the triangle can become irritated by the same factors leading to:
The L4/5 & L5/S1 facet joints may be osteo-arthritic and may cause pain from irritation of the lining of the joint. However arthritis of the facet joints causing more than stiffness is thankfully quite rare.
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retrolisthesis of L4 to the L5 with suggestion of spondylolysis at L5 and facet arthropathy at L4-5 and L5-S1.
Grade 1 retrolisthesis of l5 on s1 - Answers on HealthTap Answers from doctors on grade 1 retrolisthesis of l5 on s1.
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Patients with lumbar disk disease canpresent with back pain or a radicular painsyndrome. The classic sciatic syndrome consists of stiffness in the back and pain radiating down tothe thighs, calves and feet, associated with paresthesias, weakness, and reflex changes. The pain fromintervertebral disk disease is exacerbated by coughing, sneezing, or physical activity. Pain is usuallyworse when sitting, and with straightening or elevating the leg. Disk herniations occur most oftenat the lower lumbar levels - 90% at L4-5 and L5-S1, 7% at L3-4, and remaining 3% at the upper 2levels.
He presented with X-rays from 2006 that showed a grade I retrolisthesis or movement of one vertebra on another at the fourth and fifth lumbar level with associated X-ray damage seen of the facet joints at this level. (See Figure 1.) This is consistent with laxity of the ligaments at this level. Physical examination found tenderness to palpation at the levels of the third, fourth and fifth lumbar vertebrae as well as the right sacroiliac joint. In Canada, a physiotherapist who takes additional training and examinations in orthopedic manual medicine (manual orthopedic physical therapists) is considered an expert in assisting in the diagnosis and recovery of patients such as Freddie. He was also seen by one of six national examiners for manual orthopedic physical therapy who found areas of hypo (decreased) and hyper (increased) mobility in his lumbar spine as well as various factors related to de-conditioning brought on by his longstanding pain.
In most of the cases, this condition is a result of the rupture or deterioration of these discs. When the disc is damaged, the vertebra lying above loses support and slips out of its position putting pressure on the vertebra below the disc. It usually occurs in the lumbar region of the spinal column, more prominent at the L3-L4 or L4-L5 levels.
X-ray from August of 2006 showed a grade 1 retrolisthesis of L4 to the L5 with suggestion of spondylolysis at L5 and facet arthropathy at L4-5 and L5-S1. Follow up images from July 2009, demonstrated no retrolisthesis, corresponding with relief of the patient’s back pain.
Physical examination identified laxity in his lower lumbar spine at levels L3, L4, and L5 as well as right sacrum. Concurrent examination by a manual orthopedic physical therapist (national examiner) demonstrated a flexion hypermobility at L5-S1, hypomobility at L4-5, hypermobility at L2-3, and right sacroiliac joint dysfunction.