ABSTRACT
OBJECTIVE: To determine the effects of stabilization exercises on pain and function in patients with degenerative spondylolisthesis. STUDY DESIGN: Nonrandomized clinical trial, with 6 months of follow up. METHODS: Twenty patients over 50 years of age with degenerative spondylolisthesis underwent a 6-month, home-based training program of stabilization exercises. We applied functional and pain scales (Visual Analogue Scale [VAS] and Oswestry Disability Index [ODI]), and conducted an isokinetic trunk test. Statistical analysis included a T test for quantitative variables, a chi-squared test for qualitative data, and Pearson correlations. The significance alfa level was 0.05. RESULTS: Both pain and Oswestry Index scores were significantly decreased. Initial and final VAS "back pain" results were 63.50 ± 18.05 mm and 43.4 ± 22.09 (p=0.007) respectively. Initial and final VAS "sciatic pain" results were 53.65 ± 29.03 mm and 36.65 ± 27.21 (p=0.035) respectively. Oswestry Index at the beginning of the study was 30.35 ± 15.6%, decreasing to a final 20.15 ± 13.6% (p=0.007). The results of VAS and ODI scores correlated significantly with improvement in the isokinetic test. CONCLUSION: Lumbar stabilization exercises could be an effective treatment option in controlling pain and improving function in patients with degenerative spondylolisthesis. Further investigation with randomized controlled trials is necessary to obtain confirmation of these results.
Subject(s)
Exercise Therapy/methods , Pain/rehabilitation , Spondylolisthesis/rehabilitation , Aged , Aged, 80 and over , Disability Evaluation , Female , Humans , Lumbar Vertebrae , Male , Middle Aged , Pain/physiopathology , Pain Measurement , Spondylolisthesis/physiopathology , Surveys and Questionnaires , Treatment OutcomeABSTRACT
A espondilólise é um defeito na pars interarticularis da vértebra com descontinuidade óssea do segmento intervertebral; a progressão do defeito resulta em deslizamento de uma vértebra sobre a outra, chamado espondilolistese, o que pode provocar dor. O tratamento não-cirúrgico é a escolha inicial na maioria dos casos de espondilolistese, mas poucos estudos verificam a eficácia dos tratamentos conservadores. O objetivo deste estudo foi realizar uma revisão da literatura sobre esses tratamentos, sobretudo no que concerne à terapia manual, a fim de ajudar os terapeutas na prescrição de intervenções eficazes. Os resultados mostram que tanto a terapia manual como a fisioterapia convencional apresentam efeitos benéficos na redução da dor lombar e na melhora funcional do paciente. As terapias manuais envolvem manipulação da coluna vertebral e articulação sacroilíaca, músculo-energia e alongamento dos músculos afetados. Exercícios de estabilização lombopélvica, fortalecimento dos músculos posturais e alongamento dos isquiotibiais e psoas também foram considerados importantes. O paciente deve ser avaliado individualmente em seu quadro clínico e radiográfico para determinação do plano de tratamento. Dentre as opções conservadoras de tratamento encontradas, nenhuma se mostrou conclusivamente superior às outras e todas podem ser incluídas no tratamento sintomático de pacientes com espondilólise/listese.
Spondylolysis is a defect in the pars interarticularis of a vertebra with a disruption in the intervertebral segment. Progression of the defect leads to one vertebra slipping over another - which is called spondylolisthesis - which may cause low-back pain. Non-surgical treatment is the initial course of action in most cases of spondylolisthesis. However, few studies have assessed the efficacy of conservative treatment. The purpose of the present study is to review literature on conservative treatment for spondylolysis/listhesis, especially manual therapy, in order to guide practitioners for effective intervention. Results show that both manual therapy and conventional physiotherapy were effective in relieving low-back pain and beneficial for patient's functional outcome. Manual therapy involved spine manipulation, sacroiliac joint manipulation, muscle-energy techniques and stretching affected muscles. Stabilizing lombopelvic exercises, postural muscles strengthening, and hamstring and psoas stretching were also considered important in treating spondylolysis/listhesis. Each case's clinical and radiological features must be individually considered in order to determinate therapeutic strategy. Among non-surgical options, none has proved better than others and all may be included in symptomatic treatment of patients with spondylolysis/listhesis.
Subject(s)
Humans , Child , Adolescent , Young Adult , Middle Aged , Spondylolisthesis/rehabilitation , Musculoskeletal Manipulations , Spinal Osteophytosis/rehabilitation , Physical Therapy ModalitiesABSTRACT
El tratamiento de la espondilósis lumbar, con espondilolistesis menor de 25 por ciento, es una artrodesis muy usada que produce la consecuente limitación en la movilidad, menor soporte y poca tolerancia para el esfuerzo. Con el uso de sistemas de fijación transpedicular se reducen estas complicaciones además del riesgo de pseudoartrosis, estabilizando la columna, aliviando la sintomatología, la biomecánica de la columna y propiciando un mayor porcentaje de consolidación. En este estudio preliminar, se trataron tres pacientes que no respondieron a los tratamiento conservadores descomprimiendo, mediante este método, las raíces nerviosas sin que hasta el momento se observen complicaciones postoperatorias, por lo que se recomienda el uso de estos fijadores
Subject(s)
Humans , Male , Adolescent , Adult , Orthopedics , Arthrodesis , Spondylolisthesis/surgery , Spondylolisthesis/rehabilitation , Spondylolysis/surgery , Spondylolysis/rehabilitationABSTRACT
Revisamos 8 casos de Espondilolistesis Displásica en niños y adolescentes tratados con Artrodesis Posterolateral in situ, en el Hospital San Juan de Dios de Caracas entre los años 1976 y 1990, con un seguimiento a mediano plazo. En 6 casos obtuvimos excelentes resultados y en los 2 restantes obtuvimos malos resultados ya que fueron reintervenidos. Se realizó la laminectomía descompresiva de la quinta vértebra lumbar en los casos con déficit neurológico asociado. Este estudio demuestra que para Espondilolistesis Displásica en niños y adolescentes la Artrodesis Vertebral Posterolateral in situ logra resultados satisfactorios
Subject(s)
Humans , Male , Female , Pregnancy , Adolescent , Arthrodesis , Laminectomy , Orthopedics/classification , Spondylolisthesis/rehabilitationABSTRACT
En los politraumatizados por accidentes de tránsito, caídas, etc. el traumatismo vértebro medular (T.V.M.) cervical con espondilotistesis constitiye una patología frecuente en nuestro país. El autor presenta un nuevo diseño de acero inoxidable que se coloca en estos casos por abordaje anterior, cumpliendo los requisitos de fijar y estabilizar la columna desde C3 hasta D2. Se anotan las ventajas de la misma.