Question 4 Answers: Neurosurgery

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Eccentric topic of the Week
Question 4:

What is the most common cause of low back pain in people less than 35 years old?

A. Herniated nucleus pulposus
B. Degenerative disk disease
C. Trauma
D. Scoliosis
E. Spondylolisthesis


Answer:

E. Spondylolisthesis,

"Spondylolisthesis" refers to slippage of one vertebral body on another vertebral body, Most commonly, the superior vertebra translates forward on the inferior vertebra, causing an anterolisthesis.

The most common symptom of spondylolisthesis is low back pain Many times, a patient can develop a lesion (spondylolysis) between the ages of 5 and 7, but not present symptoms until they are 30~35 (normally after a sudden twisting or lifting motion that causes an acute episode of back and leg pain).

Degenerative diseases, such as arthritis and stress fractures, are common causes.

Traditional treatments include either a "posterior or anterior surgical approach, or a combined anterior-posterior approach", with reduction of the subluxation.

Grande I - the upper verteba has slipped forward < 25% of the total width of the vertebral body
Grade II - 25-50%
Grade III - 50 - 75%
Grade IV > 75% (if the upper vertebral body has slid all the way forward off the front of the lower vertebral body - referred to as spondyloptosis).

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