Date: Fri, 19 Jun 1998 08:13:02 -0400 From: "Noel A. Taylor" Subject: Re: Grade 3 Spondy At 06:25 PM 6/17/98 -0700, Lisa wrote: >I have a patient with a grade three spondylolisthesis due to a >spondylolysis. The fracture is an old one from about 15 years ago or >so. He has radiating leg pain (from picking up a tool box 2 years ago) >on the left which is severe with numbness on the top of his foot. Bowel >and bladder function is intact. He squats to reduce the pain. > >My question is does anyone have any previous experience as to how long >and how often a patient with a grade 3 spondy should be treated? Do >patients with spondy 3's become pain free? I have been treating him >with Cox-Flexion and drop. I have only treated him twice and >improvement (no more numbness on the top of the foot, just throbbing >pain) has been seen already. Also has anyone done any >traction/compression x-rays to evaluate stability? Lisa: Doing post-tx films without clinical need is not allowed in my state, so I cannot comment on visible effectiveness. I have had many patients with spondylolisthesis of the same etiology as your patient's, who respond beautifully to supine table-drop on a sacral wedge. The average time from severe pain to no pain seems to be one week, and the average course of acute care three weeks. Supportive care in the form of 3-8 visits a year depending on the individual patient has proved effective. Hope this helps. --Noel ------------------ Date: Fri, 19 Jun 1998 22:29:16 -0700 From: "Bob Woolery, DC" Subject: Re: Grade 3 Spondy Inversion traction helps relieve many cases of spondy pain. I ordered an Orthopod for one Spondy patient, and lent mine to another. I hesitate to mention Dan Murphy after the last firestorm, but he had done long term studies of inversion traction, combined with the flexion low back moves typical of CBP (No. 2 moves). In the case of one patient, the key happened to be getting a stable atlas correction! He had tried care with at least 50 DCs over the previous 15 years, and gotten just enough results to keep trying new ones. We have been seeing him since mid- 1994, and he still shows up every month or 6 weeks plus when he hurts himself. Very satisfying case! One reason for the lesser response with previous doctors may be the ASR- ASL atlas, equivalent to a straight posterior occiput in Gonstead terminology. Supine atlas moves contacting the posterior arch with the MCP simply drive one side further into misalignment. Bob Woolery, DC ------------------- From: Jay M. Trennoche Date: Saturday, June 20, 1998 4:13 PM Subject: Fw: Grade 3 Spondy Noel and original spondy message sender...ditto...except no wedge, but supine drop through the abdomen...awesome...learned it from Vern Pierce. Same adjusting schedule...it may be for life, though. What's yopu take on that Noel. El Trennocher ----------------- From: "Christophe Dean" Subject: Re: Grade 3 Spondy Date: Mon, 22 Jun 1998 09:37:00 -0400 Jay, The move you describe was originally taught by Clay Thompson. Knees are slightly flexed, contact is made immediately above the pubic bone, tissue pull (for lack of a better term) is a slow deep depression of this lower aspect of the abdomen, adjustment is a sharp, SHALLOW (cause it can hurt if you really drill them) thrust A-P and slightly superior. Two or three drops usually brings dramatic symptomatic relief. Activator method checks Spondy by (after the pelvis and low aback are cleared) placing the hand on the side of PD (L5) or opposite the side of PD (L4) across the low back and having the patient lift the upper trunk slightly off the table and return. a shortening of the PD leg indicates an ACTIVE spondy. Correction is an AP/superior trust on the segment above and an AP/inferior thrust on the segment below. This is just FYI (and because I'm a big fan of Clay's, God rest his soul) and is probably the kind of information we should be exchanging on this list. Christophe ------------------ From: "Barb Gauthier" Subject: Re: Grade 3 Spondy Date: Wed, 24 Jun 1998 11:06:04 PDT Christophe, and listers.... I was taught a little differently how to do this move and would like some clarification.... The way it was presented in Thompson class and in club... Supine, knees bent, contact lightly slightly below and lateral to the navel, set the drop to very light tension, have the patient breathe in, breathe out, and as they exhale follow them down with very light pressure....just enough so the table drops at the end of the exhalation....NO thrusting....... The only other way we were taught was to adjust the segments above and below...especially below, ex) for L5 spondy...adjust sacrum as a Base Posterior.... Thanks for any corrections/input..... Barb Gauthier ---------------- From: "Christophe Dean" Subject: Re: Grade 3 Spondy Date: Thu, 25 Jun 1998 16:01:32 -0400 Barb, Fundamentally, no argument. This is what I meant by a SHALLOW thrust. It is rapid and high velocity to start the drop mechanism but does NOT bottom out. I do not recall the thrust being lateral to the navel. The primary intent was to vector the thrust into the body of L5 at the angle of the L5/S1 disc. Pulsating aortic aneurism would obviously be a contraindication, so would a full bladder ;-). I have always thrusted on inspiration because the upward me\ovement of the diaphragm pulls abdominal content up and out of the way leaving my contact closer to the body of L5. Christophe ---------------- Date: Sun, 28 Jun 1998 18:18:32 +0200 From: "Dr.Thomas V. Giordano" Subject: Re: Grade 3 Spondy, with a question for the list Bob, If you were to concede that this move is reasonable, then, by all means, thrust upon EXHALATION, not Inhalation. I've never resorted to this move with spondys, as I find the anterior drop that you have described much more comfortable and stabilizing. Even in this move, I have the patient EXHALE and drop at full exhalation. As far as Dr. Dean's experiment, perhaps you've read it incorrectly! ----------------- From: "RCS" <7RCSX@email.msn.com> Subject: Re: Grade 3 Spondy Date: Thu, 25 Jun 1998 22:07:52 -0500 I would think that a specific thrust on soft tissue to move a lower lumbar posteriorly would hold an inherent danger of trauma leading to bleeding. I have found that a much safer technic is to place the patient supine, flex both knees upon the lower abdomen so that the lumbar curve is drawn kyphotic, and apply a mild thrust just below the patella with your forearm held horizontal. Thus, the force is not applied with a small piercing object (ie, pisiform) but with the patient's thighs acting as a broad lever to shift the lordotic segment posteriorly. However, to each his own. RCS ----------------- Date: Sat, 20 Jun 1998 07:39:33 -0400 (EDT) From: "Stephen Perle, DC" Subject: Re: Grade 3 Spondy In 1989 I went to an ACA Sports Council Seminar where Terry Yochum talked about a patient he consulted on when he was in Australia. The doc brought in these films of a grade V (there was no contact between the two vertebral bodies) of L5/S1. The had had LBP for a few weeks. Terry showed the doc to motion palpate the patient to find the area of restriction. I believe it was SI. So the doc adjusted the SI and the patient became aSx. When I saw Terry he had just recently come bck from Australia and checked up on this patient. He found that the guy was still aSx ten years later. You should note, with surprise that this patient had for I believe it was 18 years been an Australian rules football player. The point Terry was making is that if stable the spondy is irrelevant. Stephen M. Perle, D.C. -----------------------