Spondylolisthesis Replies
Troy Fink, CPO
Description
Collection
Title:
Spondylolisthesis Replies
Creator:
Troy Fink, CPO
Date:
2/17/2021
Text:
Thanks to all who responded.
I will be using an LSO as described, but will increase lordosis to 10 degrees.
Original post:
I have a 15 y/o female gymnast pt with lower lumbar spondylolisthesis. It has been several years since I have had to treat this condition. In the past I have always used an anterior overlap polyethylene LSO made in 0 degrees lordosis. Is this still the standard? How do you treat it?
Responses:
That’s how we treat it--You're handling things beautifully! --That’s exactly what I would still do,( maybe not 0deg if she can’t get close, perhaps against a wall in 1/2 squat to cue post pelvic tilt and contracting abs to assess)--I have done dozens of these and I do the same but I always use a hip Spica and have it locked or at least set the rom to not full extension or full flexion.--Any LSO with 0 to 5 degrees lordosis that can be cinched tight will do just fine.
--
The idea is to reduce the lumbar lordosis by forming a gap behind the lumbar spine so that when you tighten the brace, the abdominal panel will flatten the lordosis, thus pushing backward on the anteriorly-displaced L5.
--
Choosing from our brace line-up, a Panther MP would work well, unless she is unusually tall for a 15-year-old gymnast, in which case you might choose the Panther SP. Other races will work just as well. Just be sure to get one with a rigid posterior plate.--Yes, but if she is athletic you may change lordosis to 10 degrees. Larger stiffer gluteal require more lordosis. Overlap LSO, 23 hours per day for 6-8 week or until physician releases--I would agree with design except for lordosis. She is most likely hyperlordotic and your goal is total contact/immobilization/pain control. Your lordosis should be the position that she can comfortably get to. So decrease lordosis according to her flexibility which most likely is not very flexible. No one can get to 0 degrees
--Yup
--That sounds correct to me. Been a while here too!
--Spinal Technologies makes a lovely, affordable lordosis reducing LSO that helps a ton. Made to measurements. Just make sure patient dons in supine with hip and knee flexion to reduce lordosis.
--I've had success with that model, as well as a bivalve MPE LSO. It seems to really reduce the lordosis better, although at the cost of being a bit bulkier.
--Yes, Boston Overlap Brace (BOB). Some no longer put at zero lordosis but rather half the current lordotic curve. So if the patient has 30° lordosis, you would reduce to 15°. Seems to gain greater compliance.
--Used lots of bauerfiend 0637 lso. Pretty comfy good PT compliance
--Thanks again!
Troy Fink, CPO
I will be using an LSO as described, but will increase lordosis to 10 degrees.
Original post:
I have a 15 y/o female gymnast pt with lower lumbar spondylolisthesis. It has been several years since I have had to treat this condition. In the past I have always used an anterior overlap polyethylene LSO made in 0 degrees lordosis. Is this still the standard? How do you treat it?
Responses:
That’s how we treat it--You're handling things beautifully! --That’s exactly what I would still do,( maybe not 0deg if she can’t get close, perhaps against a wall in 1/2 squat to cue post pelvic tilt and contracting abs to assess)--I have done dozens of these and I do the same but I always use a hip Spica and have it locked or at least set the rom to not full extension or full flexion.--Any LSO with 0 to 5 degrees lordosis that can be cinched tight will do just fine.
--
The idea is to reduce the lumbar lordosis by forming a gap behind the lumbar spine so that when you tighten the brace, the abdominal panel will flatten the lordosis, thus pushing backward on the anteriorly-displaced L5.
--
Choosing from our brace line-up, a Panther MP would work well, unless she is unusually tall for a 15-year-old gymnast, in which case you might choose the Panther SP. Other races will work just as well. Just be sure to get one with a rigid posterior plate.--Yes, but if she is athletic you may change lordosis to 10 degrees. Larger stiffer gluteal require more lordosis. Overlap LSO, 23 hours per day for 6-8 week or until physician releases--I would agree with design except for lordosis. She is most likely hyperlordotic and your goal is total contact/immobilization/pain control. Your lordosis should be the position that she can comfortably get to. So decrease lordosis according to her flexibility which most likely is not very flexible. No one can get to 0 degrees
--Yup
--That sounds correct to me. Been a while here too!
--Spinal Technologies makes a lovely, affordable lordosis reducing LSO that helps a ton. Made to measurements. Just make sure patient dons in supine with hip and knee flexion to reduce lordosis.
--I've had success with that model, as well as a bivalve MPE LSO. It seems to really reduce the lordosis better, although at the cost of being a bit bulkier.
--Yes, Boston Overlap Brace (BOB). Some no longer put at zero lordosis but rather half the current lordotic curve. So if the patient has 30° lordosis, you would reduce to 15°. Seems to gain greater compliance.
--Used lots of bauerfiend 0637 lso. Pretty comfy good PT compliance
--Thanks again!
Troy Fink, CPO
Citation
Troy Fink, CPO, “Spondylolisthesis Replies,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/255311.
