Spondylolisthesis

Look Standing

  1. Front:
    • Symmetric pelvic and shoulder height.
  2. Side:
    • Hyperlordotic lumbar spine or flattened lumbar spine.
    • Short, sharp kyphosis.
  3. Back:
    • Check for stigmata of dysraphism (e.g., Spina bifida).
    • Look for heart-shaped buttocks, which can be due to a retroverted pelvis and vertical sacrum.
    • Assess for scoliosis, which may be due to muscle spasm.
    • Palpate the lower lumbar spine for a step deformity.

Feel Standing

  1. Pain:
    • Check for pain in the lower lumbar spine, paraspinal pain, and sacroiliac (SI) pain.
  2. Step Deformity:
    • Identify any step deformity in the lower lumbar spine.
  3. Paraspinal Pain:
    • Palpate for muscle spasms and tenderness in the paraspinal muscles.

Move Standing

  1. Range of Motion:
    • Global restricted lumbar spine movements.
    • Schober Test:
      • Reduced, indicating restricted flexion.
  2. Gait:
    • Observe a waddling gait, often normal despite pathology.

Lying Down

  1. Assess Hamstrings Tightness:
    • Perform the Straight Leg Raise (SLR) or drop kick test.
  2. Full Neurologic Assessment:
    • Sensory examination, tone, power, reflexes.

Finishing

  1. Perianal and PR Examination:
    • Check for perianal sensation and any abnormalities during a rectal examination.
  2. Vascular Examination:
    • Ensure no signs of vascular compromise.
  3. Radiographs:
    • Obtain AP, lateral, and oblique views.
  4. Advanced Imaging:
    • MRI or CT scan to assess for soft tissue involvement, neural compression, and precise grade of spondylolisthesis.
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