Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 76. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 744 Section Spinal Deformities and Malformations Nerve Root Block A nerve root block can be helpful in deciding equivocal cases of neural compression and radiculopathy see Chapter 10 . Particularly in degenerative spondylolisthesis a nerve root block can be also used to support non-operative treatment. Particularly in postoperative spondylolisthesis myelography and postmyelo-CT are valuable Functional Myelography CT myelography has been surpassed by MRI for the vast majority of indications. However it is helpful in cases with contraindications for MRI . pacemaker functional stenosis postoperative iatrogenic spondylolisthesis Myelography alone is of limited use. Because a complete block of contrast fluid is occasionally found the degree of pathology especially of nerve root compression is not adequately visualized. Without doubt there is the advantage of envisaging the implications of lumbar flexion extension for the spinal canal Fig. 5 yet in our opinion the invasive method only has true value if a consecutive CT myelography is performed. In cases where a postoperative spondylolisthesis is suspected Wiltse Type IV we routinely perform myelography and myelo-CT. This enables us to determine the degree of instability as well as the amount of postoperative scarring which is important for planning surgery. Figure 5. Functional myelography a b Functional myelography of an unstable spondylolisthesis demonstrating a narrowing of the spinal canal in extension at the level of L4 5 compared to flexion. Spondylolisthesis Chapter 27 745 Non-operative Treatment In the management of spondylolisthesis the spine specialist needs to take into account various important aspects which will crucially influence the treatment decision and modality Table 3 Table 3. Factors influencing treatment natural history neurologic deficit grade of slippage severity of complaints lumbosacral anatomy duration of symptoms age comorbidities Natural History Some spondylolistheses progress to severe .
