Page 118 - ASOP ROT Study Guide

Possible causes are:
♦ spondylosis - degeneration of the intervertebral disc leading to increased loading of the facet joints

which then develop secondary osteoarthritis.
♦ primary osteoarthritis - the facet joints are likely to be as prone to primary osteoarthritis as any other

synovial joint.

However, there are probably many other causes, still to be determined, which involve the ligaments and
muscles.

Clinical presentation
Mechanical back pain tends to recur but this does not necessarily indicate that the condition is
deteriorating. There is no known cure for mechanical back pain but the judicious use of rest,
physiotherapy and medication will help the sufferer through a bad episode.

Management
Most people must learn to live with their bad back and learn how to try to prevent recurrences. Support
should be provided by general practitioners with assistance from physiotherapists and orthopaedic
specialists. Alternative medical practitioners such as osteopaths and chiropractors can provide some
easing of the condition by manipulation. It is important however that everyone concerned, including the
patient, is clear that the cause of most backache is unknown, is mostly not serious, and will get better
with time.

4 . 1 . 3 Spondylolisthesis

This is a not uncommon finding in association with low back pain. The term refers to the slippage of one
vertebra relative to the one below and is commonly seen in the lumbar spine. It is caused by a bony
abnormality which interferes with the stability of the facet joints and their associated bony and
ligamentous elements.

http://orthoinfo.aaos.org/topic.cfm?topi
c=a00053

Etiology
The condition may be congenital or it may be acquired, so it may occur at any age including infancy.
There is no need to know the detail of congenital conditions at this stage.

Adult forms of this condition are thought to be acquired, although some may be mild congenital
abnormalities which have gone unnoticed previously. It appears to be acquired following an acute or,
more likely, a fatigue fracture of the pars interarticularis.

Clinical presentation
Someone with this condition experiences low back pain which is almost identical to mechanical back
pain. Diagnosis is nearly always made using X-ray techniques, although in severe slippage a step may
be felt at the affected area. The condition very rarely causes neurological problems, even when the
slippage is major. In the case of congenital spondylolisthesis, which is rare, the movement between
the two vertebrae may be sufficient to damage nerve tissues.