Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic mechanical low back pain, exacerbated by prolonged standing and lumbar extension. Symptoms are consistent with Grade I L4-L5 degenerative spondylolisthesis. Reports intermittent radicular symptoms in the L4-L5 distribution, relieved by sitting or lumbar flexion. No bowel/bladder dysfunction or progressive neurological deficits noted.
Clinical Examination Findings
Lumbar spine examination reveals palpable step-off at the L4-L5 level. Range of motion is restricted in extension due to pain. Neurological exam: motor strength 5/5 in bilateral lower extremities; sensation intact to light touch in L4 and L5 dermatomes; patellar and Achilles reflexes symmetric and 2+; negative straight leg raise test bilaterally.
Treatment Protocol
Conservative management initiated: physical therapy focusing on core stabilization and lumbar flexion exercises. Prescribed NSAIDs for inflammation and pain control. Activity modification advised to avoid heavy lifting and hyperextension. Follow-up imaging in 6 months to monitor for progression of slippage.