Degenerative spondylolisthesis: diagnosis and treatment of degenerative spondylolisthesis.Latest update: September 2008. Next update: 2011. Patient group: Adults with low back pain and/or lower extremity symptoms related to spinal stenosis. Intended audience: Practitioners who treat patients with degenerative lumbar spondylolisthesis spondylolisthesis /spon·dy·lo·lis·the·sis/ (-lis´the-sis) forward displacement of a vertebra over a lower segment, usually of the fourth or fifth lumbar vertebra due to a developmental defect in the pars interarticularis. . Additional versions: Nil. Expert working group: Eighteen doctors from the USA comprised the guideline development group. Funded by: North American Spine Society. Consultation with: North American Spine Society members. Representatives from medical, interventional and surgical spine specialties are reported to have participated in the development and review of these guidelines. Approved by: The North American Spine Society. Location: http://www.spine.org/Pages/ PracticePolicy/ClinicalCare/ClinicalGuidlines/Default. aspx. Description: This 134-page document reviews the evidence for the diagnosis and treatment of degenerative lumbar spondylolisthesis. It begins with a consensus on the definition and natural history of degenerative lumbar spondylolisthesis, with recommendations for further research to assist to refine these. The main body of the guidelines relates to diagnosis and treatment. In the first section on diagnostic tests and imaging, evidence is presented and recommendations are made for the use of historical and physical examination findings, radiographs, MRI 1. (application) MRI - Magnetic Resonance Imaging. 2. MRI - Measurement Requirements and Interface. , myelography Myelography Definition Myelography is an x-ray examination of the spinal canal. A contrast agent is injected through a needle into the space around the spinal cord to display the spinal cord, spinal canal, and nerve roots on an x ray. , and CT scans to diagnose degenerative lumbar spondylolisthesis. Next, outcome measures to indicate effects of treatment are reviewed, with recommendations for the use of primarily questionnaires. In the evidence for treatment, the group found no studies to adequately determine the role of medical/interventional treatment in this population. This includes pharmacological treatment, physiotherapy/exercise, manipulation, epidural epidural /epi·du·ral/ (-dur´il) situated upon or outside the dura mater. ep·i·du·ral adj. Located on or over the dura mater. n. steroid injections, or ancillary treatments such as bracing, or transcutaneous electrical stimulation. It is recommended that medical/interventional management should be similar to symptomatic, degenerative lumbar spinal stenosis. The rest of the guidelines discusses the evidence for surgical interventions including surgical decompression, lumbar fusion, the addition of instrumentation to these methods, and the long-term result of surgical management. Sandra Brauer The University of Queensland The University of Queensland (UQ) is the longest-established university in the state of Queensland, Australia, a member of Australia's Group of Eight, and the Sandstone Universities. It is also a founding member of the international Universitas 21 organisation. |
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