Spondylolisthesis describes the anterior displacement of a vertebra or the vertebral column in relation to the vertebrae below. It was first described in 1782 by Belgian obstetrician, Dr. Herbinaux.

He reported a bony prominence anterior to the sacrum that obstructed the vagina of a small number of patients. The term “spondylolisthesis” was coined in 1854, from the Greek “spondyl” for vertebrae and “olisthesis” for slip.

The variant “listhesis” is sometimes applied in conjunction with scoliosis. These “slips” occur most commonly in the lumbar spine.

Failed back syndrome (FBS), also called “failed back surgery syndrome” (FBSS), refers to chronic back and/or leg pain that occurs after back (spinal) surgery. It is characterized as a chronic pain syndrome. Multiple factors can contribute to the onset or development of FBS.

Contributing factors include but are not limited to residual or recurrent disc herniation, persistent post-operative pressure on a spinal nerve, altered joint mobility, joint hypermobility with instability, scar tissue (fibrosis), depression, anxiety, sleeplessness and spinal muscular deconditioning.

An individual may be predisposed to the development of FBS due to systemic disorders such as diabetes, autoimmune disease and peripheral blood vessels (vascular) disease. Smoking is a risk for poor recovery.

Common symptoms associated with FBS include diffuse, dull and aching pain involving the back and/or legs. Abnormal sensibility may include sharp, pricking, and stabbing pain in the extremities. The term “post-laminectomy syndrome” is used by some doctors to indicate the same condition as failed back syndrome.

The treatments of post-laminectomy syndrome include physical therapy, minor nerve blocks, transcutaneous electrical nerve stimulation (TENS), behavioral medicine, non-steroidal anti-inflammatory (NSAID) medications, membrane stabilizers, antidepressants, spinal cord stimulation, and intracathecal morphine pump. Use of epidural steroid injections may be minimally helpful in some cases. The targeted anatomic use of a potent anti-inflammatory anti-TNF therapeutics is being investigated.

The amount of spinal surgery varies around the world. The most is performed in the United States and Holland. The least in the United Kingdom and Sweden. Recently, there have been calls for more aggressive surgical treatment in Europe. Success rates of spinal surgery vary for many reasons.

Complex regional pain syndrome (CRPS) is an uncommon, chronic condition that usually affects your arm or leg. Rarely, complex regional pain syndrome can affect other parts of your body.

Complex regional pain syndrome is marked by intense burning or aching pain. You may also experience swelling, skin discoloration, altered temperature, abnormal sweating and hypersensitivity in the affected area.

The cause of complex regional pain syndrome isn’t clearly understood, though it often follows an illness or injury. Treatment for complex regional pain syndrome is most effective when started early. In such cases, dramatic improvement and even remission are possible.

The main symptom of complex regional pain syndrome is intense pain, which gets worse over time. Additional signs and symptoms include:

• “Burning” pain in your arm, leg, hand or foot.
• Skin sensitivity.
• Changes in skin temperature color and texture. At times your skin may be sweaty; at other times it may be cold. Skin color can range from white and mottled to red or blue. Skin may become tender, thin or shiny in the affected area.
• Changes in hair and nail growth.
• Joint stiffness, swelling and damage.
• Muscle spasms, weakness and loss (atrophy).
• Decreased ability to move the affected body part.

Symptoms may change over time and vary from person to person. Most commonly, swelling, redness, noticeable changes in temperature and hypersensitivity (particularly to cold and touch) occur first. Over time, the affected limb can become cold and pale and undergo skin and nail changes as well as muscle spasms and tightening. Once these changes occur, the condition is often irreversible.

Complex regional pain syndrome occurs in two types with similar signs and symptoms, but different causes:

• Type 1. Previously known as reflex sympathetic dystrophy syndrome, this type occurs after an illness or injury that didn’t directly damage the nerves in your affected limb. About 90 percent of people with complex regional pain syndrome have type 1.
• Type 2. Once referred to as causalgia, this type follows a distinct nerve injury.

Many cases of complex regional pain syndrome occur after a forceful trauma to an arm or a leg, such as a gunshot wound or shrapnel blast. Other major and minor traumas — such as surgery, heart attacks, infections, fractures and even sprained ankles — also can lead to complex regional pain syndrome. It’s not well understood why these injuries can trigger complex regional pain syndrome

Diagnosis of complex regional pain syndrome is based on a physical exam and your medical history. There is no single test that can definitively diagnose complex regional pain syndrome, but the following procedures may provide important clues:

• Bone scan. A radioactive substance injected into one of your veins permits viewing of your bones with a special camera. This procedure may show increased circulation to the joints in the affected area.
• Sympathetic nervous system tests. These tests look for disturbances in your sympathetic nervous system. For example, thermography measures the skin temperature and blood flow of your affected and unaffected limbs. Other tests can measure the amount of sweat on both limbs. Dissimilar results can indicate complex regional pain syndrome.
• X-rays. Loss of minerals from your bones may show up on an X-ray in later stages of the disease.
• Magnetic resonance imaging (MRI). Images captured by an MRI device may show a number of tissue changes.

Dramatic improvement and even remission of complex regional pain syndrome is possible if treatment begins within a few months of your first symptoms. Often, a combination of various therapies is necessary. Your doctor will tailor your treatment based on your specific case. Treatment options include:

Medications

Doctors use various medications to treat the symptoms of complex regional pain syndrome. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve), may ease pain and inflammation. In some cases, doctors may recommend prescription medications. For example, antidepressants, such as amitriptyline, and anticonvulsants, such as gabapentin (Neurontin), are used to treat pain that originates from a damaged nerve (neuropathic pain). Corticosteroids, such as prednisone, may reduce inflammation.

Your doctor may suggest bone-loss medications, such as alendronate (Fosamax) and calcitonin (Miacalcin). Opioid medications may be another option. Taken in appropriate doses, they may provide acceptable control of pain. However, they may not be appropriate if you have a history of substance abuse or lung disease.

Some pain medications, such as COX-2 inhibitors (Celebrex), may increase your risk of heart attack and stroke. It’s wise to discuss your individual risks with your doctor.

Therapies

• Applying heat and cold. Applying cold may relieve swelling and sweating. If the affected area is cool, applying heat may offer relief.
• Topical analgesics. Various creams are available that may reduce hypersensitivity, such as lidocaine or a combination of ketamine, clonidine and amitriptyline.
• Physical therapy. Gentle, guided exercising of the affected limbs may improve range of motion and strength. The earlier the disease is diagnosed, the more effective exercises may be.
• Sympathetic nerve-blocking medication. Injection of an anesthetic to block pain fibers in your affected nerves may relieve pain in some people.
• Transcutaneous electrical nerve stimulation (TENS). Chronic pain is sometimes eased by applying electrical impulses to nerve endings.
• Biofeedback. In some cases, learning biofeedback techniques may help. In biofeedback, you learn to become more aware of your body so that you can relax your body and relieve pain.
• Spinal cord stimulation. Your doctor inserts tiny electrodes along your spinal cord. A small electrical current delivered to the spinal cord results in pain relief.

Peripheral neuropathy, in its most common form, causes pain and numbness in your hands and feet. The pain typically is described as tingling or burning, while the loss of sensation often is compared to the feeling of wearing a thin stocking or glove.

Peripheral neuropathy can result from such problems as traumatic injuries, infections, metabolic problems and exposure to toxins. One of the most common causes of the disorder is diabetes.

In many cases, peripheral neuropathy symptoms improve with time — especially if it’s caused by an underlying condition that can be resolved. Medications initially designed to treat other conditions, such as epilepsy and depression, are often used to reduce the painful symptoms of peripheral neuropathy.

Your nervous system is divided into two broad categories. Your central nervous system consists of your brain and spinal cord. All the other nerves in your body are part of your peripheral nervous system, which includes:

• Sensory nerves to receive feelings such as heat, pain or touch
• Motor nerves that control how your muscles move
• Autonomic nerves that control such automatic functions as blood pressure, heart rate, digestion and bladder function

Most commonly, peripheral neuropathy begins in the longest nerves — the ones that reach to your toes. Specific symptoms vary, depending on which types of nerves are affected. Signs and symptoms may include:

• Gradual onset of numbness and tingling in your feet or hands, which may spread upwards into your legs and arms
• Burning pain
• Sharp, jabbing or electric-like pain
• Extreme sensitivity to touch, even light touch
• Lack of coordination
• Muscle weakness or paralysis if motor nerves are affected
• Bowel or bladder problems if autonomic nerves are affected

A number of factors can cause neuropathies. These factors include:

• Trauma or pressure on the nerve. Nerve pressure can result from using a cast or crutches, spending a long time in an unnatural position, repeating a motion many times — such as typing at a computer keyboard — or having a tumor or abnormal bone growth. When peripheral neuropathy affects a single nerve, trauma or nerve pressure is the most likely cause.
• Diabetes. When damage occurs to several nerves, the cause frequently is diabetes. At least half of all people with diabetes develop some type of neuropathy.
• Vitamin deficiencies. B vitamins are particularly important to nerve health.
• Alcoholism. Many alcoholics develop peripheral neuropathy because they have poor dietary habits, leading to vitamin deficiencies.
• Autoimmune diseases. These include lupus, rheumatoid arthritis and Guillain-Barre syndrome.
• Other diseases. Kidney disease, liver disease and an underactive thyroid (hypothyroidism) also can cause peripheral neuropathy. Patients with HIV/AIDS also are prone to develop peripheral neuropathy.
• Inherited disorders. Examples include Charcot-Marie-Tooth disease and amyloid polyneuropathy.
• Exposure to poisons. These may include some toxic substances, such as heavy metals, and certain medications — especially those used to treat cancer.

Unfortunately, it’s not always easy to pinpoint the cause of peripheral neuropathy. In fact, if your neuropathy isn’t associated with diabetes, it’s possible the cause may never be found.

What are risk factors for peripheral neuropathy? Peripheral neuropathy risk factors include:

• Diabetes, especially if your sugar levels are poorly controlled
• Alcohol abuse
• Vitamin deficiencies, particularly B vitamins
• Immune system suppression, which occurs in people who have received organ transplants and people with AIDS, among others
• Autoimmune diseases, such as rheumatoid arthritis and lupus, in which the immune system attacks your own tissues
• Kidney, liver or thyroid disorders

Peripheral neuropathy isn’t a single disease, but rather a symptom with many potential causes. For that reason it can be difficult to diagnose. To help in the diagnosis, your doctor will likely take a full medical history and perform a physical and neurological exam that may include checking your tendon reflexes, your muscle strength and tone, your ability to feel certain sensations, and your posture and coordination.

Your doctor may also request blood tests to check your level of vitamin B-12, a urinalysis, thyroid function tests and, often, electromyography — a test that measures the electrical discharges produced in your muscles. As a part of this test, you’ll be asked to have a nerve conduction study, which measures how quickly your nerves carry electrical signals. A nerve conduction study is often used to diagnose carpal tunnel syndrome and other peripheral nerve disorders.

Your doctor may recommend a nerve biopsy, a procedure in which a small portion of a nerve is removed and examined for abnormalities. But even a nerve biopsy may not always reveal what’s damaging your nerves.

The first goal of treatment is to manage the condition causing your neuropathy. If the underlying cause is corrected, the neuropathy often improves on its own. The second goal of treatment is to relieve the painful symptoms. Many types of medications can be used to relieve the pain of peripheral neuropathy.

• Pain relievers. Mild symptoms may be relieved by over-the-counter pain medications. For more severe symptoms, your doctor may recommend prescription painkillers. Drugs containing opiates, such as codeine, can lead to dependence, constipation or sedation, so these drugs are prescribed only when other treatments fail.
• Anti-seizure medications. Drugs such as gabapentin (Neurontin), topiramate (Topamax), pregabalin (Lyrica), carbamazepine (Tegretol) and phenytoin (Dilantin) were originally developed to treat epilepsy. However, doctors often also prescribe them for nerve pain. Side effects may include drowsiness and dizziness.
• Lidocaine patch. This patch contains the topical anesthetic lidocaine. You apply it to the area where your pain is most severe, and you can use up to three patches a day to relieve pain. This treatment has almost no side effects except, for some people, a rash at the site of the patch.
• Antidepressants. Tricyclic antidepressant medications, such as amitriptyline and nortriptyline (Pamelor), were originally developed to treat depression. However, they have been found to help relieve pain by interfering with chemical processes in your brain and spinal cord that cause you to feel pain. The selective serotonin and norepinephrine reuptake inhibitor duloxetine (Cymbalta) also has proved effective for peripheral neuropathy caused by diabetes.
• Spinal Cord Stimulation. Peripheral neuropathy that does not get better with the treatments listed above may respond very well to spinal cord stimulation.