Transcript of video
Spondylolisthesis causes, symptoms and treatment are reviewed by leading Boston-based spine surgeon. When spondylolisthesis progresses to degree that requires surgical treatment? Dr. Anton Titov, MD. How to differentiate between spondylolisthesis symptoms and peripheral vascular disease in the legs? Dr. Anton Titov, MD. Because both diseases cause intermittent claudication. How and when to treat spondylolisthesis surgically? Dr. Anton Titov, MD. What variations of spondylolisthesis surgery exist? Dr. Anton Titov, MD. Spondylolisthesis: causes, symptoms, treatment. Spondylolisthesis surgery medical second opinion. Video interview with leading expert in spine surgery. Understanding degenerative spondylolisthesis: vertebrae start to misalign. There is a forward slippage of one vertebra over another. Non-surgical treatment for spondylolisthesis is strengthening of core muscle of torso and pelvis. Decision to do surgery for degenerative spondylolisthesis depends on three principles. Spondylolisthesis causes symptoms in all patients. In many surgical treatment is required. The principles are: 1 How severe are symptoms of spondylolisthesis? Dr. Anton Titov, MD. 2 How patient responded to initial conservative therapy? Dr. Anton Titov, MD. Such as exercise and flexibility. 3 How bad spondylolisthesis looks on spine MRI. Medical second opinion can confirm degenerative spondylolisthesis diagnosis. Medical second opinion in spondylolisthesis also helps to choose the best non-surgical or surgical treatment. Get medical second opinion on spondylolisthesis and be confident that your treatment is the best. It is important to distinguish the symptoms of spondylolisthesis from symptoms of peripheral vascular disease. Spondylolisthesis causes and symptoms are important to observe carefully. Treatment of spondylolisthesis often requires extensive surgical operation. Character of pain and what makes the pain better or worse are key factors in differential diagnosis. Spondylolisthesis surgery recovery takes couple of months if surgery is done correctly. Spondylolisthesis physical therapy treatment is tried first, and then spinal fusion surgery for Isthmic Spondylolisthesis should be considered. Non-surgical treatment also includes spondylolisthesis exercises. Spondylolisthesis surgery medical second opinion. Intermittent claudication peripheral vascular disease differential diagnosis. Dr. Anton Titov, MD. Spondylolisthesis is the forward displacement of vertebrae. It is quite common, especially in L5 vertebral body in the lumbar area. What kind of symptoms do patients with spondylolisthesis experience? Dr. Anton Titov, MD. What are the appropriate diagnostic and treatment steps for patients with spondylolisthesis? Dr. Anton Titov, MD. Dr. Eric Woodard, MD. Spine neurosurgeon, Boston, former Chief, Spine Surgery, BWH, Harvard Medical School. As the spine ages spondylolisthesis is one of the several factors that contribute to spinal stenosis. Spinal stenosis is a narrowing of the spinal cord canal. Spinal stenosis leads to pinching of the nerves and symptoms. The spondylolisthesis is a particular situation in . This the vertebrae start to misalign. There is a forward slippage of one vertebral body over the other. Most commonly spondylolisthesis occurs at lumbar vertebral body number four on number five. It is much more common in postmenopausal women. This is probably due to hormonal effect on the health of the joints between lumbar vertebral body number four and number five. When the joints become suitably arthritic there is a mechanical failure of the joints. the body weight tends to pull the torso forward on the pelvis. It occurs most commonly at L4 and L5 vertebrae. The stenosis is a narrowing of spinal canal that causes pinching of the nerves. There is an associated experience of leg pain and hip pain. The pain appears especially when assuming certain positions, such as the upright position. with certain activities such as walking. Classically we call it claudicating leg pain intermittent claudication. With every step the legs become heavier and heavier, and more and more painful. Until such time that the patient has to sit at rest for a few minutes. Then patient with spondylolisthesis regains their strength. then they can go on for another 100 yards or two hundred yards before they have to sit again. This is a syndrome called claudicating leg pain intermittent claudication. it is characteristic of spinal stenosis. Spondylolisthesis is one of the more common causes of spinal stenosis. The indications to do something surgical with regard to degenerative spondylolisthesis again gets us back to our principles. The principles are: 1 What is the severity of symptoms? Dr. Anton Titov, MD. 2 What is response to initial conservative therapy, such as exercise and flexibility? Dr. Anton Titov, MD. and 3 How severe is it on the radiograph? Dr. Anton Titov, MD. [on spine MRI] All those three things have to be put together with progression of pain. certainly with any weakness of the legs. That is a pretty strong indicator for surgical treatment. Dr. Anton Titov, MD. What is the typical surgical treatment for the spondylolisthesis? Dr. Anton Titov, MD. Dr. Eric Woodard ,MD: The principle of treatment for spondylolisthesis is to release the spinal stenosis. Basically to release the the spinal nerve pinching. there are variety of ways to do that. Increasingly today there are a variety of novel ways to release the spinal stenosis. But also there are methods to stabilize or reposition the vertebrae that have slipped forward. This is most typically done with removal of the roof for the spinal canal. This surgery is called laminectomy. Laminectomy releases the nerves and stops the pinching. But it is also done to stabilize vertebrae, typically with a spinal fusion type procedure of the two vertebrae to arrest the slipping process. There have been a whole variety and enormous interest in the industry in the last three decades of providing technology to stabilize and reposition the spine in patients with spondylolisthesis. Pedicle screws have been developed since the mid 1980s. pedicle screws are very commonly used now to provide a firm grip on lumbar vertebral bodies number four and number five. Pedicle screws help to prevent further slippage and hold vertebral bodies still. Pedicle screws then allow a bone graft that is placed between lumbar vertebral bodies number four and five to then fuse vertebral bodies four and five together. Some more of the modern techniques involve less and less invasiveness or openness of the surgery. These minimally invasive techniques are called percutaneous techniques. They require only a small incisions for computer-aided placement of such technologies as pedicle screws. Dr. Anton Titov, MD. Dr. Anton Titov, MD. You mentioned intermittent claudication as one of the symptoms of spondylolisthesis. Intermittent claudication is also common with peripheral vascular disease. Because of overlapping demographics of patients with spondylolisthesis and with peripheral vascular disease. It also causes the pain and the weakness in the legs. In your practice how do you distinguish the symptoms of spondylolisthesis from symptoms of peripheral vascular disease? Dr. Anton Titov, MD. Because patients could have multiple reasons for problems with their legs? Dr. Anton Titov, MD. Dr. Eric Woodard, MD. Excellent question. Typically the patient with peripheral vascular occlusion and what we call peripheral vascular disease have much more dominant symptoms involving the calves and the feet. Patients with peripheral vascular disease have much less of a back pain component to it as opposed to lumbar spinal claudication intermittent claudication. Typically the activities that cause any increased demand on blood flow also will cause symptoms. Whereas in lumbar spinal stenosis it is the position of the lumbar spine and pelvis . This initiate the symptoms. Symptoms of spondylolisthesis are due to an increase in the mechanical stress on the the lumbar spine. one of the classic differentiators that we inquire about is whether symptoms are produced solely with walking. Or there are symptoms also produced when patients are hunched forward on a stationary bike? Dr. Anton Titov, MD. The lumbar stenosis spondylolisthesis patients are perfectly comfortable on a stationary bike. in fact they will tell you that the hunch forward position such as leaning on a shopping cart or on a stationary bike is perfectly fine. It does not produce symptoms in patients with spondylolisthesis intermittent claudication. Person with vascular claudication, however, is still symptomatic in that kind of an activity. there is less of a positional component to it in vascular claudication intermittent claudication. there is a much more of a distal involvement, typically at the calves. Spondylolisthesis causes, symptoms, treatment. Video interview with leading spine surgeon. Surgery or not for spondylolisthesis? Dr. Anton Titov, MD. Intermittent claudication sign.