Spondylolisthesis and disc protrusion

[asha]

The patient a 55 year old male has an anterolisthesis of L5 over Sacrum ( GRADE I) and Disc protrusion at L3-4 . Patient is also a Bronchitis patient.

The patient presents with buttock pain left sided with radiating pain down the whole lower limb. i've not assessed him completely for muscle strength, sensation.. etc.. Pain increases on sitting and walking short distances. Also dyspnoea on exertion.

There are a lot more details needed in this case. It is pretty simple.
1- Does the pain increase with cough & sneeze? as the patient is bronchitic.
2- what does sitting on soft surfaces or on hard surfaces do to his pain?
3- what does supine & prone positions do to his pain.
4- what is his SLR & his other examinations throw up?
What could be giving him his symptoms may be the disc or the listhesis. spondy's are better sitting. central disc protrusions are better walking. stenosis is out because they are better sitting not worse. This seems to be a case of a symptomatic postero-lat disc, from the limited information I have . Reduce it & the job is done. It has to be done carefully though, as the listhesis seem's to be silent now, dont make it symptomatic with your treatment. Core work up will do well at the end of the session, but it should be done without loading the disc.
asha

[alophysio]

Hi,

Peter O'Sullivan did his PhD work in this area. The relevant is...

O'Sullivan PB, Twomey LT and Allison GT (1997) Evaluation of Specific Stabilizing Exercise in the Treatment of Chronic Low Back Pain With Radiologic Diagnosis of Spondylolysis or Spondylolisthesis. Spine, Volume 22(24). December 15, 1997.2959-2967

Abstract

Study Design. A randomized, controlled trial, test-retest design, with a 3-, 6-, and 30-month postal questionnaire follow-up.

Objective. To determine the efficacy of a specific exercise intervention in the treatment of patients with chronic low back pain
and a radiologic diagnosis of spondylolysis or spondylolisthesis.

Summary of Background Data. A recent focus in the physiotherapy management of patients with back pain has been the specific training of muscles surrounding the spine (deep abdominal muscles and lumbar multifidus), considered to provide dynamic stability and fine control to the lumbar spine. In no study have researchers evaluated the efficacy of this intervention in a population with chronic low back pain where the anatomic stability of the spine was compromised.

Methods. Forty-four patients with this condition were assigned randomly to two treatment groups. The first group underwent a 10-week specific exercise treatment program involving the specific training of the deep abdominal muscles, with co-activation of the lumbar multifidus proximal to the pars defects. The activation of these muscles was incorporated into previously aggravating static postures and functional tasks. The control group underwent treatment as directed by their treating practitioner.

Results. After intervention, the specific exercise group showed a statistically significant reduction in pain intensity and functional disability levels, which was maintained at a 30-month follow-up. The control group showed no significant change in these parameters after intervention or at follow-up.

Summary. A "specific exercise" treatment approach appears more effective than other commonly prescribed conservative treatment programs in patients with chronically symptomatic spondylolysis or spondylolisthesis.

Hope this helps!