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Posted on 03-30-2014

Spondylolisthesis in Baltimore, MD

As I have spoken about in several other blog posts, there are many causes of lower back pain. Part of the challenge (but fun!) of being a chiropractor is trying to determine which structure or structures in any given patient are responsible for their presenting lower back pain.

One form of lower back pain that is not given much attention but is never the less important is spondylolisthesis. Though it is hard to pronounce, it is easy to describe. It is a condition where one bone slides forward on another bone. There are several types of spondylolisthesis, but the type that I come across most clinically and are the most challenging to treat clinically are spondylolytic spondylolistheses.  These are mainly seen in the lower back (lumbar spine) at the L5/S1 level, although not exclusively.

In spondylolytic spondylolisthesis the posterior aspect of a bone undergoes a systematic overload of force that leads to an eventual acute bony fracture. If this occurs on both sides of the posterior aspect of a bone the vertebral body can actually slide forward on the bone below it, causing not only back spasms and pain, but in some cases, instability. These are generally developed in youth with hyperextension loading mechanisms such as those seen in baseball pitches, wrestlers, and young dancers.

While high velocity low amplitude chiropractic spinal manipulation (what patients refer to as "back cracking") is used on many patients with acute and chronic lower back pain in my office, it is not the only tool that I use to treat lower back pain. Though not an absolute contraindication to spinal manipulation, chiropractors and PTs need to exercise caution when handling spondylolisthesis patients.

The question that comes to mind is how to best help with the symptoms of pain and whether or not the spondylolisthesis is stable (not going to slide) or unstable (active and able to keep sliding).

Traditionally, SPECT bone scans have been used to determine clinically active sites of nuclear uptake which correlate with active acute spondylolistheses. While this has helped to determine the cause of active and unstable spondylolisthesis, it has recently come to light that the degree of exposure to patients to radioactive material has made these tests less desirable.

Fortunately a more readily available less deleterious test exists that is highly specific in detecting active spondylolisthesis in Baltimore, MD. The test is referred to as a STIR imaged MRI. STIR stands for short tau inversion recovery. It is a "fat suppression technique" that looks for signs of edema and fluid changes in and around the pars interarticularis- the location of spondylolytic spondylolistheses.

As a Baltimore Chiropractor that treats patients with acute and chronic lower back pain including active and inactive spondylolytic spondylolisthesis it is important to understand the use of STIR MRI imaging and what it means for patient outcome and treatment recommendations. I will discuss management of these conditions in a future blog post and how to determine whether it is appropriate to avoid activity, continue activity, undergo chiropractic care, or undergo bracing and/or surgical fusion.

For now, if you, or someone you know is suffering from lower back pain including spondylolisthesis please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Dr. Gulitz

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