Pars defect steroid injection

Other common diseases that result from endocrine dysfunction include Addison’s disease , Cushing’s disease and Grave’s disease . Cushing's disease and Addison's disease are pathologies involving the dysfunction of the adrenal gland. Dysfunction in the adrenal gland could be due to primary or secondary factors and can result in hypercortisolism or hypocortisolism . Cushing’s disease is characterized by the hypersecretion of the adrenocorticotropic hormone (ACTH) due to a pituitary adenoma that ultimately causes endogenous hypercortisolism by stimulating the adrenal glands. [10] Some clinical signs of Cushing’s disease include obesity, moon face, and hirsutism. [11] Addison's disease is an endocrine disease that results from hypocortisolism caused by adrenal gland insufficiency. Adrenal insufficiency is significant because it is correlated with decreased ability to maintain blood pressure and blood sugar, a defect that can prove to be fatal. [12]

Conservative Treatment of Lower Back Pain When to Have Neck Surgery When to have Lower Back Surgery Neck and Back Pain Medications Spinal Cord and Peripheral Nerve Stimulation Treatment: Diagnostic Cervical Discograms Lumbar Discograms EMG/NCV- Electromyograms and Nerve Conduction Studies Epidural Injections and Selective Nerve Root Blocks- Diagnostic and Therapeutic Facet Blocks and Rhizotomies Pain Diary Instructions for Spinal Injections Treatment: Surgical Lumbar Microdiscectomy Transforaminal Lumbar Interbody Fusion (TLIF) Anterior Cervical Decompression & Fusion (ACDF) Laminotomy Lumbar Fusion Types Failed Spine Surgery Correction Cervical Laminectomy, Laminoplasty and Posterior Cervical Fusion Scoliosis Surgery Posterior Cervical Decompression and Posterior Cervical Foramenotomy Artificial Disc Replacement (ADR) for Cervical Spine Artificial Disc Replacement (ADR) for Lumbar Spine Surgical Repair of Pars Interarticularis Fractures Without Degenerative Disc Changes

Of the listed answers, single photon emission computed tomography (SPECT) is the most sensitive imaging modality to diagnose spondylolysis when AP and lateral radiographs are normal. Initial imaging studies should first include AP and lateral radiographs, which demonstrate 80% of defects, and oblique radiographs which demonstrate an additional 15% of defects. If no lesion is seen on plain radiogaphs, SPECT can be considered as a diagnostic study. Conventional lumbar spine MRI techniques are valuable for demonstrating normality of the pars, but may be associated with a high false positive rate for the diagnosis of pars defects.

The cited reference by Gregory et al. showed that single photon emission computerized tomography can be an effective tool to diagnosis spondylolysis in young patients with back pain.

Illustration A, B, and C demonstrate single photon emission computed tomography images in a patient with spondylolysis.

The patient's clinical presentation is consistent with degenerative spondylolisthesis of L4-5 that has failed a multimodal course of non-operative therapy. Correct management includes posterior decompression and fusion of the unstable segments.

Degenerative spondylolisthesis is the combination of spinal stenosis with intersegmental instability of the vertebrae. It most commonly affects L4/5 disc space, causing neurogenic claudication and rarely, cauda equina syndrome. Initial treatment is non-operative and includes physical therapy, pain control and injections. If non-operative measures fail, surgical management includes posterior decompression with fusion of the unstable segments with or without instrumentation.

Weinstein et al. presented 304 patients with degenerative spondylolisthesis who were treated with observation or operative management (laminectomy, plus/minus fusion). While the intent to treat analysis showed no benefit of surgery, an as-treated analysis showed operative management to have significantly better results with regards to pain relief and improvement in function.

Abdu et al. presented 380 patients who were treated surgically for degenerative spondylolisthesis. In addition to a decompressive laminectomy, patients underwent either posterolateral in situ fusion, posterolateral instrumented fusion with pedicle screws, or posterolateral instrumented fusion with pedicle screws plus interbody fusion. No consistent differences were found amongst the varying surgical procedures at 4 years follow-up.

Kornblum et al. presented 47 patients with single-level degenerative spondylolisthesis treated operatively with posterior decompression and bilateral posterolateral arthrodesis with autogenous bone graft. They found good to excellent clinical outcomes in 86% of patients with a solid arthrodesis, while only 56% of patients with a pseudoarthrosis had good to excellent clinical results. They conclude that a solid arthrodesis is key to maintaining long-term clinical results.

Figures A and B show anterolisthesis of L4 on L5 with > 4mm of translation on flexion and extension radiographs, classifying it as unstable. Figures C and D show his MRI scan with severe spinal canal narrowing.

Incorrect Answers:
Answer 1: Decompression without fusion does not address the instability of the involved spinal segments.
Answer 2: The patient has failed non-operative management, and further attempts with activity restriction will likely be unsuccessful.
Answer 3: Bilateral microdiscectomy will not address the patient's spinal stenosis or unstable segments.
Answer 5: The patient does not have evidence of instability at the L5-S1 level.

Pars defect steroid injection

pars defect steroid injection

The patient's clinical presentation is consistent with degenerative spondylolisthesis of L4-5 that has failed a multimodal course of non-operative therapy. Correct management includes posterior decompression and fusion of the unstable segments.

Degenerative spondylolisthesis is the combination of spinal stenosis with intersegmental instability of the vertebrae. It most commonly affects L4/5 disc space, causing neurogenic claudication and rarely, cauda equina syndrome. Initial treatment is non-operative and includes physical therapy, pain control and injections. If non-operative measures fail, surgical management includes posterior decompression with fusion of the unstable segments with or without instrumentation.

Weinstein et al. presented 304 patients with degenerative spondylolisthesis who were treated with observation or operative management (laminectomy, plus/minus fusion). While the intent to treat analysis showed no benefit of surgery, an as-treated analysis showed operative management to have significantly better results with regards to pain relief and improvement in function.

Abdu et al. presented 380 patients who were treated surgically for degenerative spondylolisthesis. In addition to a decompressive laminectomy, patients underwent either posterolateral in situ fusion, posterolateral instrumented fusion with pedicle screws, or posterolateral instrumented fusion with pedicle screws plus interbody fusion. No consistent differences were found amongst the varying surgical procedures at 4 years follow-up.

Kornblum et al. presented 47 patients with single-level degenerative spondylolisthesis treated operatively with posterior decompression and bilateral posterolateral arthrodesis with autogenous bone graft. They found good to excellent clinical outcomes in 86% of patients with a solid arthrodesis, while only 56% of patients with a pseudoarthrosis had good to excellent clinical results. They conclude that a solid arthrodesis is key to maintaining long-term clinical results.

Figures A and B show anterolisthesis of L4 on L5 with > 4mm of translation on flexion and extension radiographs, classifying it as unstable. Figures C and D show his MRI scan with severe spinal canal narrowing.

Incorrect Answers:
Answer 1: Decompression without fusion does not address the instability of the involved spinal segments.
Answer 2: The patient has failed non-operative management, and further attempts with activity restriction will likely be unsuccessful.
Answer 3: Bilateral microdiscectomy will not address the patient's spinal stenosis or unstable segments.
Answer 5: The patient does not have evidence of instability at the L5-S1 level.

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