Vanti Carla, Ferrari Silvano, Guccione Andrew A, Pillastrini Paolo
Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138, Bologna, Italy.
Department of Rehabilitation Science, College of Health and Human Services, George Mason University, Fairfax, VA, 22030, USA.
Arch Physiother. 2021 Aug 9;11(1):19. doi: 10.1186/s40945-021-00113-2.
There is weak relationship between the presence of lumbar spondylolisthesis [SPL] and low back pain that is not always associated with instability, either at the involved lumbar segment or at different spinal levels. Therefore patients with lumbar symptomatic SPL can be divided into stable and unstable, based on the level of mobility during flexion and extension movements as general classifications for diagnostic and therapeutic purposes. Different opinions persist about best treatment (conservative vs. surgical) and among conservative treatments, on the type, dosage, and progression of physical therapy procedures.
The aim of this Masterclass is to provide clinicians evidence-based indications for assessment and conservative treatment of SPL, taking into consideration some subgroups related to specific clinical presentations.
This Masterclass addresses the different phases of the assessment of a patient with SPL, including history, imaging, physical exam, and questionnaires on disability and cognitive-behavioral components. Regarding conservative treatment, self- management approaches and graded supervised training, including therapeutic relationships, information and education, are explained. Primary therapeutic procedures for pain control, recovery of the function and the mobility through therapeutic exercise, passive mobilization and antalgic techniques are suggested. Moreover, some guidance is provided on conservative treatment in specific clinical presentations (lumbar SPL with radiating pain and/or lumbar stenosis, SPL complicated by other factors, and SPL in adolescents) and the number/duration of sessions.
Some steps to improve the diagnostic-therapeutic approach in SPL are to identify the best cluster of clinical tests, define different lumbar SPL subgroups, and investigate the effects of treatments based on that classification, similarly to the approach already proposed for non-specific LBP.
腰椎滑脱（SPL）的存在与腰痛之间的关系较弱，且这种疼痛并不总是与受累腰椎节段或不同脊柱水平的不稳定相关。因此，出于诊断和治疗目的进行一般分类时，有症状的腰椎SPL患者可根据屈伸运动时的活动程度分为稳定型和不稳定型。关于最佳治疗方法（保守治疗与手术治疗）以及在保守治疗中，对于物理治疗程序的类型、剂量和进展，仍存在不同意见。
本大师班的目的是为临床医生提供基于证据的SPL评估和保守治疗指征，同时考虑到与特定临床表现相关的一些亚组情况。
本大师班阐述了SPL患者评估的不同阶段，包括病史、影像学检查、体格检查以及关于残疾和认知行为成分的问卷。关于保守治疗，解释了自我管理方法和分级监督训练，包括治疗关系、信息和教育。建议采用主要的治疗程序来控制疼痛、通过治疗性锻炼、被动活动和止痛技术恢复功能和活动能力。此外，还针对特定临床表现（伴有放射性疼痛和/或腰椎管狭窄症的腰椎SPL、合并其他因素的SPL以及青少年SPL）的保守治疗以及治疗疗程的数量/时长提供了一些指导。
改善SPL诊断治疗方法的一些步骤包括确定最佳的临床检查组合、定义不同的腰椎SPL亚组，并根据该分类研究治疗效果，类似于已针对非特异性腰痛提出的方法。
