ABSTRACT
As degenerative changes progress in the aging population, more patients will present with degenerative spondylolisthesis. The clinical picture is usually of a woman older than 50 years of age with a degenerative lumbar spondylolisthesis at L5 with symptoms of neurogenic claudication or radiculopathy. Imaging studies will reveal a central recess, a lateral recess or both, and/or neuroforaminal stenosis. When patients do not respond to nonoperative treatments, surgical intervention is indicated. Most studies have concluded that the addition of an arthrodesis improves the clinical outcome. A recent longterm study showed that a solid fusion and an adequate decompression is the procedure offering the best outcome. The current authors will review the pathogenesis, clinical picture, and treatment recommendations for degenerative lumbar spondylolisthesis.
Subject(s)
Lumbar Vertebrae/surgery , Spinal Stenosis/surgery , Spondylolisthesis/surgery , Aged , Decompression, Surgical , Diagnosis, Differential , Female , Humans , Internal Fixators , Middle Aged , Spinal Fusion , Spinal Stenosis/complications , Spinal Stenosis/diagnosis , Spondylolisthesis/complications , Spondylolisthesis/diagnosisSubject(s)
Faculty, Medical , Orthopedics/education , Staff Development , Adult , Career Choice , Faculty, Medical/statistics & numerical data , Female , Humans , Internship and Residency , Male , Orthopedics/classification , Orthopedics/statistics & numerical data , Private Practice/statistics & numerical data , Schools, Medical , Sex Factors , Staff Development/classification , Time Factors , United States/epidemiologyABSTRACT
Most lateral ankle sprains heal with conservative treatment. Pain that lasts 6 or more weeks after a sprain may come from inadequate rehabilitation, impingement, occult osteochondral or chondral lesions, peroneal tendon or syndesmosis injury, or lateral instability. Treatment for inadequate rehabilitation includes supervised rehabilitation and home exercise. Surgery is recommended for refractory cases of impingement syndrome. Occult osteochondral or chondral lesions usually require arthroscopic excision or repair. Peroneal tendon injury should be treated conservatively before surgery is considered. The severity of syndesmosis injury determines conservative or surgical measures. Remedies for lateral instability include an ankle brace, physiotherapy, and surgery.
