Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic mechanical low back pain, localized to the lumbosacral junction, exacerbated by lumbar extension and prolonged standing. Pain is described as dull, aching, and occasionally radiating to the buttocks or posterior thighs, consistent with L5-S1 isthmic spondylolisthesis. No bowel/bladder dysfunction or saddle anesthesia reported.
Clinical Examination Findings
Lumbar spine examination reveals palpable step-off deformity at the L5-S1 level. Range of motion is restricted in extension, eliciting localized pain. Neurological exam: motor strength 5/5 in bilateral L5 and S1 myotomes; sensation intact to light touch in L5/S1 dermatomes; deep tendon reflexes 2+ and symmetric at patellar and Achilles levels. Negative straight leg raise test.
Treatment Protocol
Conservative management initiated: activity modification, core stabilization physical therapy, and NSAIDs as needed. Patient advised to avoid hyperextension activities. Follow-up imaging in 6 months to monitor for progression of Grade 1 slip. If symptoms persist, consider epidural steroid injection or surgical consultation for stabilization.