Diseases, Disorders information

Here is an example of someone who is refractory to conservative care, rather severe central stenosis, you can see the cauda equina, is just flattened, this is someone who could walk not even half a block before she had to sit and rest, underwent a multilevel decompression as you can see here from L2 south, underwent an instrumented posterolateral fusion concordantly, due to the presence of a spondylolisthesis, which you can see here at L4-5. Female viagra increases sensitivity in women with weak libido. In randomized prospective studies, it has been shown that in the setting of a spondylolisthesis and stenosis, patient will do better with a concomitant fusion. Deformity of spondylolysis, spondylolisthesis, kyphosis and scoliosis, in general, when you see these, you will probable want to refer them because the evaluation of pain generators in deformity can be somewhat confusing, common problem, particularly in younger patient’s spondylolysis, and this is a defect in the pars interarticularis, that can be determined either in plain x-rays or on oblique films, the so-called Scottie dog sign, if you have taken the lamina and twisted it 45 degrees, someone thought this looked like a Scottie dog, where Scotti’s head is the transverse process, his pedicles the eyes, superior articular process, the ear and so forth, if Scottie is wearing a collar, that is a stress fracture commonly seen in female gymnast, particularly in adolescence, that is a spondylolysis, if Scottie is decapitated, then the vertebra is slipped and you’ve got a spondylolisthesis, and that is graded anywhere from 1 to 4, depending on the percentage of slip, grade 125 to 50 and so forth.
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These patient’s can have back pain with or without radicular irritation or neurologic entrapment, these people have a flexion preference because this is the posterior mechanical column, and in attempting to lean forward and flex, interspinous, supraspinous ligaments are getting tightened just like a string of pearls effect and that is relatively stabilizing, so these patient’s again will have a flexion preference or a sitting preference as opposed to someone with degenerative disc disease. Certainly, if the deformity progresses, it is almost invariably a surgical issue. If you pick up a high grade spondylolisthesis, a grade 3 or grade 4, particularly in an adolescent or somebody in their 20s, they will be at a high risk for progression and those patient’s should be referred immediately because that’s the group that will benefit from surgical stabilization of that. So in general, those patient’s should be referred.