Spondylolisthesis and disc protrusion

[osmangony]

Listhesis itself is completely asymptomatic untill it exertes pressure on nurvous system. In many radiograph provide subjective element of having listhesis. But most of them are completely asumptomatic.

So, dont rely on radiograph somuch for clinical decession making.

In very rare situation listhesis can produce unilateral pain. So, in ur case, lets think again about symptomatic listhesis.

The clinical image shows that the patient has postero-lateral disc harniation or protrution exerting pressure on left nerve root. No matter where. Because it is not possible to say even with clear visualized herniation on MRI that this or that disc is producing symptoms. In many cases there are big protrusion with associated smaller protrution beside its level. Who can say by any objective physical examination that this disc is producing the symptom?

So, u can perform rotation manipulation of the Lx spine under manual traction. That will be safe.

[alophysio]

Hi,

With all due respect, if there is a Xray showing a pars defect causing the anterolithesis, then DO NOT MANIPULATE. The person can be considered to have spinal instability. The disc would be the only structure providing a physical barrier to rotation.

If it is a degenerative anterolithesis - that is no pars defect, then that is a different matter.

UNlikely to be a big disc bulge or protrusion since there seems to be investigations such as CT or MRI already done. More likely to be annular compromise leading to chemical sensitisation of the nerve roots if the source of the symptoms is disc or nerve root irritation.

Don't forget his SIJ...