Figure 512

Lateral plain films of the lumbosacral spine in (A) flexion and (B) extension. Note degenerative slip at L4-L5 during flexion (A), which is reduced in extension (B).

provide symptomatic relief. Activity modification—minimizing time spent in painful postures—can be helpful as well.

Stabilization exercises combined with pelvic tilt exercises may prove helpful for those patients willing to spend the time to master these exercises and incorporate them in their daily routine. Fitness exercises, especially those performed in the pool (balneotherapy), may also offer temporary symptomatic relief. Radiofrequency neurotomy of arthritic, painful facets can bring significant long-term relief in selected patients. Patients with severe unremitting pain and neurogenic claudication could be referred for surgery. Decompression with stabilization and fusion should be considered in these patients. The future role of disc arthroplasty in this condition is still to be determined.


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