THE ROLE OF PHYSICAL MEDICINE AND KINESITHERAPY IN THE TREATMENT OF PATIENTS WITH SPONDYLOLISTESSIS

Abstract

Spondylolisthesis was first described in 1782 by Belgian obstetrician Herbinaux. The term spondylolisthesis was coined in 1854 from the Greek words spondylos - vertebra and olisthesis – slip, sliding. A large number of spinal diseases are caused by compression of the nerves in the intervertebral openings and are associated with pain and weakness not only in the spine, but also in the limbs. A classic example of such a case is Spondylolisthesis, which is characterized by displacement (slip) of the vertebral bodies, with the upper vertebral body moving forward, backward, or sideways relative to the lower one. Reasons: There are many reasons for the appearance of spondylolisthesis - congenital anomalies in the spine, traumatic injuries - in children and adolescents actively engaged in sports, during heavy physical exertion, strength exercises and degenerative changes. Spondylolisthesis occurs if a vertebra shifts as a result of a widening fracture when the muscles and ligaments holding a vertebra in place become overworked and then, the vertebral body can slide forward onto the vertebra below. The forward slip makes the spinal canal smaller, leaving less room for the nerve roots and often causing a pinched nerve. Teenagers sometimes develop a type of spondylolisthesis in which one vertebra slips forward and slides completely off the vertebra below. А pinched nerve can produce pain in the back, sciatica, which is pain that radiates down to the foot. Spondylolisthesis can also cause numbness in the foot and weakness in the muscles supplied by the affected nerve. Symptoms: In some cases, spondylolisthesis can be asymptomatic for a certain period of time. In more serious displacements, in the affected area is felt pain, muscle weakness and tingling. Usually, the pain goes to the buttock and limbs and varies according to the position of the body - it decreases when resting and lying down, and increases when standing and moving. Diagnosis: A good way to make a diagnosis is dynamic radiography of the affected area, most often the lower back. The magnetic resonance of the spine clearly shows the relationships between the bones, soft tissues and nerves, and with the help of Electromyography, it is specified which nerves are affected and the extent of the neurophysiological function disturbance. Treatment: In the early stage of the disease, with little slippage of the vertebral body, a key role is played by physical medicine and rehabilitation and kinesitherapy, which strengthen the back muscle groups involved in maintaining the shape of the spinal column, as well as the use of orthopedic aids (corsets). As the displacement of the vertebrae progresses, in addition to the symptoms of constant pain, a neurological deficit is also possible. This is an indication for operative treatment. The surgical procedure for spondylolisthesis is known as decompressive laminectomy of the lumbar spine wich free up or decompress the affected nerves. Operative treatment includes decompression of the neural structures, restoration of normal anatomical relationships between the vertebrae, and stabilization of the spine by means of fixation metal systems firmly connecting the vertebrae. The aim of the research is to evaluate the effectiveness of physical medicine and kinesitherapy in the treatment of lower back pain associated with spondylolysis and spondylolisthesis. Research methods: The research was conducted in the Recreational Center of the University "Goce Delchev", Shtip and in Banja Kežovica in the Department of Physical Medicine and Kinesitherapy, for a duration of two months, in the period from May 13th to July 8th. Results: The obtained research results suggest that physical therapy and kinesitherapy exercises, alone or in combination with other treatments, have a positive effect in reducing lower back pain due to spondylolysis and spondylolisthesis. Discussion: The goals of physical therapy for spondylolisthesis are to reduce pain, improve range of motion, and help the patient to return to normal activity levels. Physical therapy can also help to prevent further injury by teaching patients how to properly protect their spine. Conclusion: Physical therapy can help to return to normal activities by helping to reduce pain and improve mobility It may be concluded that physical therapy for spondylolisthesis can be an effective treatment option for patients with this condition. While there is no one-size-fits-all approach to treatment, physical therapy can help to improve symptoms and quality of life for many people with spondylolisthesis.