Spondylolisthesis Management

• Management of Spondylolisthesis - Triage:

  • triage for red flags, ask all special questions to rule out conditions like CES and need to determine whether pt needs to be referred on
  • pts with spondylolisthesis could have neurological signs and symptoms and this may require surgery
  • constant intense pain and constant progressive referred signs and symptoms such as neuropathic pain (radicular or radiculopathy) also all need to be flagged as such presentations could require surgical interventions
• Management of Spondylolisthesis - Stage and SIN:

  • severity and irritability may vary according to the type of illness the patient has so that needs to be determined to try determine the pain mechanism
• Management of Spondylolisthesis - Dominant Pain Mechanism:

  • mild or early Spondylolisthesis could cause nociceptive pain as theres no nerve involvement
  • as it progresses and effects the nervous system - likely nerve involvement - neuropathic pain which could present with radicular signs and symptoms. If nerve was hypoactive there might also be loss of motor power and sensation and could also be diagnosed as a radiculopathy due to Spondylolisthesis
  • a stable condition with persistent pain would be nociplastic pain - manage the signs and symptoms as this condition is no longer progressive
• Management of Spondylolisthesis - Diagnosis:

  • depends what the patients problems are when we identify them via the problem list - need to identify them and plan how to treat these signs and symptoms
  • Primary Hypothesis: Spondylolisthesis
  • Secondary Hypothesis/differential: Facet Joint / OA / Spondylosis - all these conditions can present as neuropathic pain with radicular signs and symptoms or radiculopathy (bilateral or unilateral)
  • Prognosis: Consider key factors to determine prognosis