HealthPlexus.net

Volume 12, Number 3

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Brett Rocos MB ChB MD FRCS (Tr & Orth),1, Daniel Ochieng MB ChB FRCSEd (Neuro.Surg),2,

1 Consultant Spine Surgeon, Department of Spine Surgery, Barts Health NHS Trust, London, UK.
2Complex Spine Fellow, Department of Spine Surgery, Barts Health NHS Trust, London, UK.

CLINICAL TOOLS

Abstract: Spondylolisthesis is a common finding in the adult patient but seldom requires surgical intervention. Up to 18% of the population show spondylolisthesis on spinal imaging with the vast majority requiring little or no treatment. This review explores the aetiology of spondylolisthesis, alongside key findings in the history and examination that should prompt referral, as well as presenting the evidence supporting surgical treatment. Spondylolisthesis affects patients at nearly every stage of life and understanding why and how to manage this common problem will aid in counselling patients and making the right referrals.
Key Words: Spondylolisthesis, spondylosis, back pain, radicular pain, neurogenic claudication, spinal stenosis.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
• Spondylolisthesis affects 18% of adults.
• Surgical treatment for spondylolisthesis is rarely required.
• Risk factors depend on the patient's age and include specific athletic activities, trauma and degenerative changes to the posterior elements.
• Examination findings can be normal.
• Surgical options include repair, decompression, and stabilisation of affected segments.
• Spondylolisthesis is a common incidental finding.
• Not every spondylolisthesis needs treatment.
• Uncontrolled pain is a valid reason for referral.
• Analgesia, physiotherapy, and injection therapy manage most cases successfully.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, Spondylolisthesis, spondylosis, back pain, neurogenic claudication, spinal stenosis, radicular pain

Editor's Note, Volume 12 Issue 3

D’Arcy Little, MD, CCFP, FCFP, FRCPC Medical Director, JCCC and HealthPlexus.NET

Related Terms:
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Brett Rocos MB ChB MD FRCS (Tr & Orth),1, Daniel Ochieng MB ChB FRCSEd (Neuro.Surg),2,

1 Consultant Spine Surgeon, Department of Spine Surgery, Barts Health NHS Trust, London, UK.
2Complex Spine Fellow, Department of Spine Surgery, Barts Health NHS Trust, London, UK.

CLINICAL TOOLS

Abstract: Spondylolisthesis is a common finding in the adult patient but seldom requires surgical intervention. Up to 18% of the population show spondylolisthesis on spinal imaging with the vast majority requiring little or no treatment. This review explores the aetiology of spondylolisthesis, alongside key findings in the history and examination that should prompt referral, as well as presenting the evidence supporting surgical treatment. Spondylolisthesis affects patients at nearly every stage of life and understanding why and how to manage this common problem will aid in counselling patients and making the right referrals.
Key Words: Spondylolisthesis, spondylosis, back pain, radicular pain, neurogenic claudication, spinal stenosis.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
• Spondylolisthesis affects 18% of adults.
• Surgical treatment for spondylolisthesis is rarely required.
• Risk factors depend on the patient's age and include specific athletic activities, trauma and degenerative changes to the posterior elements.
• Examination findings can be normal.
• Surgical options include repair, decompression, and stabilisation of affected segments.
• Spondylolisthesis is a common incidental finding.
• Not every spondylolisthesis needs treatment.
• Uncontrolled pain is a valid reason for referral.
• Analgesia, physiotherapy, and injection therapy manage most cases successfully.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, Spondylolisthesis, spondylosis, back pain, neurogenic claudication, spinal stenosis, radicular pain

Michael Gordon, MD, MSc, FRCPC,

Emeritus Professor of Medicine, University of Toronto, Toronto, ON.

CLINICAL TOOLS

Abstract: The evolution of medicine is quite remarkable and astounding. Modern medicine is successfully treating or providing long-term control of conditions which in the not-so-distant past were lethal or resulted in permanent disability. The strong emphasis on evidence-based medicine in today's medical profession has led to a more organized approach toward evaluating the safety and efficacy of new medical treatments. Despite attempts to meet the complex needs of an ever-aging population, an almost cynical or inherent distrust of physicians in general and their medical claims is being increasingly noted. For many physicians this has led to an uncomfortable sense of professional frustration as doubt is cast on themselves or the medical profession in general when the expectations and goals of patients or their families are not achieved. The causes of this apparent malady of contemporary medicine are myriad and may be explored from various perspectives, depending on the particular issue. To understand better the issues and challenges involved, today's medical practitioner needs to be aware of the complex mix of organizational, professional, ethical, and at times anthropological perspectives contributing to this dissonance between medical professionals and the public. Improving our insight into the forces at work in this dissonance will help medical professionals improve medical services to the public and contribute to the preservation of medicine's admirable historical legacy.
Key Words: Anti-vaccination movement, conspiracy theories, evidence-based medicine, medical quackery, trust in physicians.
Evidence-based medicine asks questions, finds and appraises the relevant data, and harnesses that information for everyday clinical practice. Evidence-based medicine follows four steps:
• Formulate a clear clinical question from a patient’s problem
• Search the literature for relevant clinical articles
• Evaluate (critically appraise) the evidence for its validity and usefulness
• Implement useful findings in clinical practice.
The growing mistrust undermines the patient-doctor relationship, as well as the public’s perspective of health care professionals and the system in general.
If the medical dissonance is left unresolved, the future of health care will become increasingly onerous for those wishing to enter its professions, ultimately impacting those in need of medical services.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Law and Ethics, anti-vaccination movement, conspiracy theories, evidence-based medicine, medical quackery, trust in physicians

I was sitting on my front porch in Toronto despite the low December temperature…

Related Terms: Medical Narratives,
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