MEDICAL REHABILITATION IN PATIENT WITH LOW BACK PAIN CAUSED BY SPONDYLOLISTHESIS GRADE I L4-L5

Abstract

Low back pain (LBP) is a prevalent condition associated with work absenteeism, disability, and large health care costs. ^1,2,3 Several studies suggest that 90% of patients with an acute episode of LBP recover within 6 weeks. Patients with LBP frequently have pain originating from multiple coexisting pain generators.⁴ LBP can result from sprains, strains, and disk protrusions, which occur in younger patients, but also from symptomatic degenerative processes, such as facet osteoarthritis, degenerative spondylolisthesis with nerve root entrapment, and degenerative lumbar spinal stenosis. ⁶ Clinical presentations of spondylolisthesis are LBP exacerbated with motion; palpable step-off noted at the slippage site; hamstring tightness. Compression of nerve roots can lead to radicular pain or neurological deficits in the lower extremities. By creating narrowing of spinal canal, it can cause psudoclaudication or compression of the cauda equina and even lead to spinchter or sexual dysfunction. The lumbar lordosis is often exaggerated in patients with spondylolisthesis, and range of motion (ROM) of the lumbar spine may be limited.^1,4 The treatment for spondylolisthesis focuses on bracing, initially limiting the offending activity, pain control, core muscle strengthening, and restoration of the range of lumbar mobility. Achieving these objectives allows the patient to return to normal activity without any type of restrictions.^7,12 Most patient with symptomatic spondylolisthesis and chronic LBP can be treated conservatively.⁷ A trial period of three to five months of aggressive conservatively treatment are indicated. ¹⁴ Surgical treatment should be considered for patients with debilitating symptoms that do not respond to conservative treatment; serious or progressive neurological deficits or neurogenic claudication.¹²