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Healthcare administration capstone projects order write for me internet of things vijay madisetti pdf free download resume for high school student graduate hello I'm dr. castanet today I'm going to explain to you spondylolisthesis spondylolisthesis literally means spine slipping and what it refers to is the slippage of one vertebra on another and I'm going to use a model to explain that this is a model of two vertebrae and the low back you can have spondylolisthesis anywhere in the spine between any two segments and spine but probably the most common places in the low back and in the second most common place would be in the neck what happens is that the vertebrae there's one above one below are connected to each other with a number of ligaments there's the one in frontier there's one in back there there's one in between the lamina here there are some between the spinous processes there are some that make up the joint capsule there are some deep in here between the spinous processes and back here between the spinous processes so there and of course the ligamentous tissues that make up the disc itself so there are a number of ligamentous tissues that hold the ver be in their appropriate position there are a couple of reasons that slippage of two vertebrae can occur one is as a result of stress and trauma to this park typically of the spine that I have marked here with a line right there this part right here of the bone is the part between the joint here and below here so we call this the pars meaning part inter meaning between articular asst meaning the joints so you can damage the pars intra-articular asst as a result of stress fracture we think typically that occurs in childhood or during teenage years it may be present on one side or may be present on both sides if you have a defect here and if it's here enough it will then fail to restrain the front part of the vertebrae from sliding forward on the back part of the vertebra we grade the severity of the slip in terms of grade one two three or four depending on whether it's fallen forward one quarter of the way half of the way three quarters of the way are all the way off of the one below so you could conceivably get a vertebra that slips forward like that a quarter of the way or half the way or three-quarters of the way or all the way off the one below below so it could actually be like that when that happens the holes here in the vertebrae that are supposed to line up so that the nerves can pass through that hole they don't line up any longer and when that happens the nerves have to pass down one hole then they have to snake back to get down to the next hole if there's too much slippage there's going to be tension on the nerve roots as they come down and try to stake their way back and down the next hole that can be a source of pain and that pain would likely be felt in the distribution of the nerves where the nerves run which means in the low back down the buttock thigh leg or foot you could get problems on one side or both sides there are occasions when that slippage depending on how severe it is and helps symptomatic it is these vertebrae may have to be surgically be placed back together and then jacked back up because typically when the vertebrae slide slides forward like that it will damage the disc below and over time that shear force will destroy the disc that collapses so the vertebrae not only have to be pulled back into the proper position but checked up as if the disc were still there and fused in that position that's a surgery that when necessary has a very good prognosis because it can result in significant symptoms the cause of the pain is too quickly easily easily known and it has already fixed surgically that's in a very small percentage of these slip cases the more common slip happens as a result of degenerative changes to the joints the joints are responsible for maintaining the relationship between the vertebrae and restraining slippage forward of one on the other if the joints become incompetent as a result of degenerative changes they will permit one vertebra to slip forward on another that is a very common phenomenon I probably see that in seven percent of older spine seven and ten percent of older spines it's usually a modest slip it's usually part of the degenerative process and it may just be an incidental finding and a red herring so to speak meaning not the cause of the pain and not unamed abal to improvement through conventional treatment whatever that may be in my experience for these degenerative slips whether their grade one and even up to degrade to perhaps they are amenable to improvement through treatment as if they didn't exist because there are lots of sources of pain and you treat any other potential source of pain and that slip is not an impediment to improving the spine and to get the person's pain reduced and they're just their ability back so I typically treat a problem like that the way I would most problems of a degenerative nature in the low back I place them on a table it's called a spinal decompression table I open up the joints and the vertebrae to get more water oxygen and nutrients into the disc that alleviates pain that is coming from any one of the typical pain generators meaning the disc nerve or joint if you do that most people will get relief the slip remains intact because these slips are typically stable meaning they slip forward but stay in that position so they may or may not be a source of pain I do think that it makes for a biomechanical vulnerability and it is a likely source of pain but it turns out that if you treat these people you don't have to correct the slip to get them feeling better that's probably true eighty-five percent of the time there's a small percentage patients that will benefit from an injection if the spinal decompression treatment does not suffice and there are some tiny percentage of people that need surgical treatment for this the important point is to do the appropriate treatment for the person starting with the more conservative and then progressing if needed to injections and lastly to surgical treatment whatever the treatment is whether it's non-surgical injection surgical the appropriate treatment in the right patient at the right time for the right problem is typically a blessing and the trick is as a clinician to be aware of all the available treatments to know when to use which to start with the most conservative and proceed accordingly as needed the unfortunate fact is though that the prevailing means of treatment ignores effective non-surgical treatment I've been in orthopedics for 18 years physical therapy and physical medicine for 18 years and spent four years part-time in a neurosurgical practice so I think I am very familiar with the surgical and non-surgical treatments when each is indicated and I can tell you that unfortunately the most effective non-surgical treatment for degenerative conditions of the spine including spondylolisthesis is ignored and that is finally compression treatment the reason spines hurt is almost always because of insult on the three pain generators discs nerves and joints if you treat those by decompressing the spine because compression is the underlying theme of all of the different lesions you might site in the spine an x-ray or MRI scan if you treat the compressive cause of the pain whether or not you have spondylolisthesis the patient's pain typically hits better and you can avoid injections and surgical treatment if I can help you with your problem please give me a call i'm dr. castanet the phone numbers for 0 for 5 58 4015 I'm in Decatur Georgia inside the perimeter and I service people from throughout the Atlanta metro area and greater Georgia area as well thanks very much bye bye do my internet of things trends 2019 Boricua College.