Dear Windy Johnson,
Thanks for your valuable opinion.
1.regarding X-rays in flexion and extension to judge stability of spondylolisthesis .I remmember
reading a paper on this subject where author of such study had declared them to be unreliable.
But we shall try to get these X-rays.
2.she have any saddle anaethesia?
After standing for few minutes to cook ,she has paresthesia spreading down in perineal region.
3.any gait disturbance?
No
4.Is she unstable in her movements - e.g. hinging at L4/5
area or jerky quality of movements.?
No.
Can you please explain briefly "In theory you could also try firing up
the local segmental multifidus."Are you referring to electrotherapy e.g TENS surge/interferentials?
Thanking you,
Dr.Sarveshwar Sood
Orthopaedic Surgeon & Head Department of Physical
Medicine & Rehabilitation,
Member American Academy Of Pain Management.
S.B.L.S.Hospital
812/1,Housing Board Colony
Model Town,Jalandhar city
Punjab State.India
E-mail [log in to unmask]
http://Personal.vsnl.com/sarvesh
----- Original Message -----
From: Wendy Johnson
To: [log in to unmask]
Sent: Saturday, February 19, 2000 12:03 AM
Subject: Re: pain & paresthesia.
Hope this helps...re: problem patient
Although she cannot afford an MRI can you do x-rays in
lumbar flexion and extension to see if that
spondylolisthesis is stable or not - it sounds very
unstable to me - re: flexed posture required
permenently and the bilateral neural signs.
I would really worry about those bilateral signs -I
know you said no bladder or bowel problems, but does
she have any saddle anaethesia? or any gait
disturbance? Are there and sensory, reflex or myotome
discrepancies? What are her neural dynamics like? Is
she unstable in her movements - e.g. hinging at L4/5
area or jerky quality of movements.?
If the spondylolisthesis is unstable I would wager
that she needs spinal fusion and there's not a great
deal that you can do externally to help her other than
pain relief and prevention of further dysfunction.
If it's not unstable then maybe try LOADS of posterior
pelvic tilts in conjunction with transversus abdominis
focussed control work. This will take a long time to
build up - especially because she's had 20 years of
pain inhibition and the pain inhibition is likely to
be continuing. In theory you could also try firing up
the local segmental multifidus (only success I've had
though requires a lot of patient perserverence and an
EMG biofeedback).
It would appear from your assessment that you follow a
"McKenzie" repeated movements pattern of assessment -
although this is a good base for back assessment I
would wager that there would be not a lot of benefit
to this poor lady - she requires STABILITY and
repetitive movement will only serve to mobilise the
already hypermobile and unstable spondylolisthesis
level.
Hope this is of some assistance. Let me know
Wendy Johnson MSc MCSP SRP MMACP
