Cervical Spondylolisthesis: Rehabilitation Options Explained

Cervical vertebra dislocation rehabilitation

Hello, recently I have experienced numbness in the last two fingers of both hands.
I visited Hospital A, where they performed a cervical X-ray and MRI, indicating that there was no nerve compression.
However, they did not inform me about the cervical spondylolisthesis and only prescribed medication without recommending rehabilitation.
Hospitals B and clinics reviewed the images from Hospital A and confirmed that although there was no nerve compression, there was indeed cervical spondylolisthesis.
They suggested traction rehabilitation, stating that the hand numbness might be caused by my neck.
After taking medication and undergoing rehabilitation for over a month, my fingers still occasionally feel numb, and I also experience neck pain.
Finally, I visited Hospital C, where they took new X-rays and confirmed the spondylolisthesis, but the doctor advised against rehabilitation to avoid exacerbating the condition.
Should I proceed with rehabilitation or not?

Suan Tong Ma, 20~29 year old female. Ask Date: 2018/01/24

Dr. Wang Huijun reply Rehabilitation

1.
Numbness in the last two fingers of both hands is theoretically more likely to be caused by cervical spine issues leading to nerve compression, but this does not necessarily mean there is a problem with the cervical spine itself.
Sometimes, it is due to long-term poor posture, and the issue may still be at the muscular level.

2.
In the aforementioned situations, rehabilitation treatment generally has a good effect in about 80% of cases.
If the rehabilitation results are not as expected, it is necessary to consider whether the underlying causes of the cervical spine or muscle issues have been addressed.
Sometimes, the frequency and duration of rehabilitation may be insufficient.
Based on my personal experience and considering your age, if your work is not physically demanding or if you have not experienced an accident that caused cervical spine injury, it is likely due to long-term poor posture.
A common modern issue is excessive smartphone usage.
Therefore, it is essential to correct the underlying causes and strengthen maintenance exercises; otherwise, it will only address the symptoms without resolving the root cause, and the original issue will persist, preventing rehabilitation from achieving optimal results.
3.
If two hospitals provide inconsistent answers regarding the issue of slippage, I recommend consulting a third hospital to clarify whether there is a slippage problem.
Otherwise, the causes and severity related to slippage, as well as the symptoms it causes in the cervical spine, can vary significantly, making it impossible to provide a simple yes or no answer.
I appreciate your understanding.
4.
Fortunately, you have undergone an MRI, which did not reveal any significant issues, so based on my personal experience, you should be able to continue with rehabilitation.
5.
Lastly, I apologize for the late response, and I appreciate your understanding.

Reply Date: 2018/01/24

More Info

Cervical spondylolisthesis is a condition where one of the cervical vertebrae slips out of place, which can lead to various symptoms, including pain, numbness, and weakness in the arms and hands. The management of this condition can be complex and often requires a multidisciplinary approach, including medication, physical therapy, and sometimes surgical intervention.

Based on your description, it seems that you have been experiencing symptoms such as numbness in your fingers and neck pain, which may be related to the cervical spondylolisthesis. The MRI findings indicate that while there is no significant nerve compression, the presence of spondylolisthesis and degenerative changes in the cervical spine can still lead to discomfort and neurological symptoms.

Rehabilitation Options
1. Physical Therapy: Physical therapy is often a cornerstone of treatment for cervical spondylolisthesis. A physical therapist can design a rehabilitation program tailored to your specific needs. This may include:
- Strengthening Exercises: Focused on the neck and upper back muscles to provide better support to the cervical spine.

- Stretching Exercises: To improve flexibility and reduce muscle tension in the neck and shoulders.

- Postural Training: To help you maintain proper alignment and reduce strain on the cervical spine during daily activities.

2. Traction Therapy: Some practitioners recommend cervical traction as a way to relieve pressure on the spine and improve alignment. However, this should be approached with caution, especially in cases of spondylolisthesis, as improper traction can exacerbate symptoms. It is crucial to have this performed under the guidance of a qualified healthcare professional.

3. Pain Management: Medications such as non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. Your current medication regimen, including Lyrica (pregabalin), is aimed at nerve pain relief, which can be beneficial for your symptoms.

4. Education and Activity Modification: Learning about your condition and how to modify activities to avoid exacerbating symptoms is essential. Ergonomic adjustments at work or home can also help reduce strain on your neck.

5. Surgical Options: If conservative treatments fail to alleviate symptoms and if there is a risk of significant neurological impairment, surgical options may be considered. This could involve stabilizing the affected vertebrae or decompressing the spinal cord or nerve roots.

When to Avoid Rehabilitation
In your case, it is essential to heed the advice of your healthcare providers. If a physician has recommended against rehabilitation due to concerns about worsening your condition, it is crucial to follow that guidance. Each case of cervical spondylolisthesis is unique, and what works for one patient may not be appropriate for another.

Conclusion
In summary, rehabilitation can be beneficial for managing symptoms associated with cervical spondylolisthesis, but it must be approached cautiously and tailored to your specific situation. It is advisable to seek a second opinion or consult a specialist in spine care or neurology if you feel uncertain about the recommendations you have received. They can provide a comprehensive evaluation and help you determine the best course of action for your rehabilitation and overall management of your cervical spine condition. Always prioritize open communication with your healthcare team to ensure that your treatment plan aligns with your symptoms and lifestyle.

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