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Traditionally, most surgeons rely on flexion-extension radiographs. However, there are some concerns about the reliability of this method. This is because the techniques used to take the X-rays are not standardized and can vary, which can lead to an underestimation of the movement between the vertebrae. [18]
52 year old male with a degenerative spondylolisthesis at L5 - S1. (A) CT sagittal view of a low grade slip. (B) Lateral radiograph pre-operative intervention. - (C) Surgically treated with L5 - S1 decompression, instrumented fusion and placement of an interbody graft between L5 and S1.
Joint stability is easily evaluated by the use of flexion and extension lateral x-ray views of the spine. A summary of part of the DRE tables (6) give a guide as to the implications of the joint instability. If either translation or angular change is determined from flexion to extension to the degree shown in the table below, then Category IV ...
Cervical X-rays may show osteophytes, decreased intervertebral disc height, narrowing of the spinal canal, and abnormal alignment (kyphosis of the cervical spine). Flexion and extension view of the cervical spine is helpful to look for spondylolisthesis (slippage of one vertebra over another).
Treatment for spondylolysis ranges from bracing, activity restriction, extension exercises, flexion exercises and deep abdominal strengthening, that is administered through physical therapy. The duration of physical therapy a patient receives varies upon the severity of spondylolysis, however typically ranges from three to six months.
The bony components that may relate to the potential for joint instability can be measured by use of x-rays. Plain film lateral x-rays can be used to evaluate for translations anteriorly (anterolisthesis) or posteriorly (retrolisthesis). Where plain films indicate the likelihood of these translations being significant, flexion-extension views ...
The McKenzie protocol also now includes flexion protocols and stresses the importance of differentiating whether flexion or extension improves patient's symptoms. As a result, McKenzie principles are used by many physical therapists in the treatment of low back pain, whereas Williams Exercises are no longer taught as a physical therapy protocol.
With increasing age, the occurrence of degenerative spondylolisthesis becomes more common. The most common spondylolisthesis occurs with slipping of L4 on L5. Frymoyer showed that spondylolisthesis with canal stenosis is more common in diabetic women who have undergone oophorectomy (removal of ovaries). The cause of symptoms in the legs can be ...