Lumbar Disc Posterolisthesis at L2–L3

Lumbar disc posterolisthesis (also called retrolisthesis or retrospondylolisthesis) refers to the posterior (backward) displacement of one vertebral body relative to the one below. At the L2–L3 level, this means the L2 vertebra slips backward on L3, narrowing the spinal canal or neural foramina and potentially compressing neural elements. The slip can be stable (static) or dynamic, worsening with extension and improving with flexion. Posterolisthesis often coexists with disc degeneration, facet joint arthropathy, and spondylolysis, leading to segmental instability, altered biomechanics, and chronic low back pain. RadiopaediaWikipedia

Lumbar disc posterolisthesis—also called retrolisthesis—is a condition in which the L2 vertebral body shifts backward relative to L3 by more than a physiological margin, without complete dislocation. This posterior slip can narrow the spinal canal or neural foramina, leading to back pain, stiffness, and possible nerve compression symptoms such as sciatica or leg weakness NCBI. While anterolisthesis (forward slip) at L4–L5 is more common, retrolisthesis at L2–L3 may arise from degenerative disc disease, facet joint arthropathy, or trauma MedicineNet.

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Types of Posterolisthesis

Posterolisthesis is classified both by severity and by etiology:

1. By Severity (Meyerding Grades):

   • Grade I: 0–25% posterior slip

   • Grade II: 26–50%

   • Grade III: 51–75%

   • Grade IV: 76–100%

   • Grade V (Spondyloptosis): >100% displacement
     These grades help guide prognosis and treatment decisions. Radiopaedia

2. By Etiology (Wiltse Classification):

   • Dysplastic (congenital facet or laminar anomalies)

   • Isthmic (pars interarticularis defect or elongation)

   • Degenerative (facet osteoarthritis and disc wear)

   • Traumatic (acute fractures of the neural arch)

   • Pathologic (bone weakening from infection or tumor)

   • Post-surgical/Iatrogenic (instability after laminectomy or fusion)
     Each type reflects a different underlying mechanism and may require tailored management. RadiopaediaWikipedia

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Causes

1. Degenerative Disc Disease: Progressive loss of disc height and hydration destabilizes the segment. Wikipedia

2. Facet Joint Osteoarthritis: Arthritic narrowing and osteophyte formation permit vertebral slip. Radiology Key

3. Pars Interarticularis Defect (Spondylolysis): A stress fracture in the pars allows the vertebra to shift posteriorly. Wikipedia

4. Acute Trauma: Vertebral fractures (e.g., burst or compression) can displace the vertebra backward. Wikipedia

5. Disc Infection (Discitis, Osteomyelitis): Inflammatory destruction of disc or bone weakens support. Wikipedia

6. Metastatic Tumor: Lytic lesions from cancer (e.g., breast, prostate) erode vertebral bodies. Wikipedia

7. Paget’s Disease of Bone: Abnormal bone remodeling leads to structural weakness. Wikipedia

8. Congenital Dysplasia: Malformed facets or laminae from birth predispose to slip. Radiopaedia

9. Post-surgical Instability: Excessive bone removal (e.g., wide laminectomy) can destabilize the segment. Radiopaedia

10. Rheumatoid Arthritis: Chronic synovial inflammation erodes facet joints and ligaments. Wikipedia

11. Ankylosing Spondylitis: Inflammatory fusion of spinal segments alters load transfer. Wikipedia

12. Neuromuscular Disorders: Conditions like muscular dystrophy cause muscle weakness and instability. Wikipedia

13. Connective Tissue Disorders: Ehlers-Danlos or Marfan syndrome produce ligamentous laxity. Wikipedia

14. Osteoporosis: Decreased bone density increases risk of vertebral endplate fractures. Wikipedia

15. Scoliosis: Abnormal curvature alters facet orientation, encouraging posterior slip on the convex side. Wikipedia

16. Obesity: Excess weight amplifies spinal loading and accelerates degeneration. Wikipedia

17. Repetitive Hyperextension: Sports (gymnastics, football) cause microtrauma to posterior elements. Wikipedia

18. Genetic Predisposition: Familial spondylolisthesis suggests inherited connective tissue weakness. Wikipedia

19. Ligamentous Injury: Sprains of the posterior longitudinal or interspinous ligaments reduce stability. Wikipedia

20. Tuberculous Spondylitis (Pott’s Disease): Mycobacterial infection can erode vertebra and allow slip. Wikipedia

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Symptoms

1. Chronic Low Back Pain: Dull ache exacerbated by standing or extension.

2. Stiffness: Reduced lumbar flexion and extension range.

3. Neurogenic Claudication: Leg pain and weakness precipitated by walking, relieved by flexion.

4. Radicular Pain: Shooting pain along the L2 or L3 dermatome (front of thigh).

5. Paresthesia: Numbness or “pins and needles” in the anterior thigh or groin.

6. Muscle Weakness: Hip flexor and quadriceps weakness (L2–L3 nerve roots).

7. Reflex Changes: Diminished patellar reflex if L3 root is involved.

8. Gait Disturbance: Trendelenburg or antalgic gait due to pain and weakness.

9. Hamstring Tightness: Protective spasm of hamstring muscles.

10. Postural Change: Increased lumbar kyphosis or flattening of lordosis.

11. Step-off Deformity: Palpable posterior step at the L2–L3 junction.

12. Mechanical Instability: Sensation of “giving way” or slipping.

13. Muscle Spasm: Involuntary contraction of paraspinal muscles.

14. Facet-mediated Pain: Localized pain worse with extension and rotation.

15. Clonus or Hyperreflexia: If spinal canal narrowing reaches upper motor neuron threshold.

16. Bladder Dysfunction: Rare, but possible with severe canal compromise.

17. Sexual Dysfunction: L3 root involvement may affect thigh adduction and sensation.

18. Weight Loss/Fever: “Red flags” suggesting infection or tumor.

19. Tenderness on Palpation: Localized pain when pressing the L2–L3 spinous process.

20. Activity-related Pain: Worse with lifting, bending backward, or prolonged standing. WikipediaVerywell Health

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Diagnostic Tests

Physical Examination

1. Inspection: Observe posture, lordosis, and step-off at L2–L3.

2. Palpation of Spinous Processes: Tenderness or step deformity over L2.

3. Range of Motion: Flexion, extension, lateral bend and rotation.

4. Gait Analysis: Antalgic or Trendelenburg patterns.

5. Neurological Exam: Assess L2–L3 myotomes (hip flexion, knee extension), dermatomes, reflexes.

6. Schober’s Test: Measures lumbar flexion via change in skin marking around L5. RadiopaediaWikipedia

Manual (Provocative) Tests

1. Straight Leg Raise: Passive leg raise to stretch L5–S1 roots (can provoke referred pain). Wikipedia

2. Slump Test: Seated spine flexion with knee extension to tension neural elements. Wikipedia

3. Kemp’s Test: Spinal extension with ipsilateral rotation—exacerbates facet pain.

4. Bowstring Test: Variant of SLR; pressure behind the knee increases sciatic nerve stretch.

5. Gaenslen’s Test: Stresses L2–L3 facets by simultaneous hip flexion and contralateral extension. Wikipedia

6. FABER (Patrick’s) Test: Flexion-ABduction-External Rotation stresses the L2–L3 facet and SI joint.

Laboratory and Pathological Tests

1. Complete Blood Count (CBC): Infection or anemia.

2. Erythrocyte Sedimentation Rate (ESR): Elevated in infection, inflammatory arthritis.

3. C-Reactive Protein (CRP): Acute-phase reactant for infection/tumor.

4. Blood Cultures: Identify bacteremia in discitis or osteomyelitis.

5. HLA-B27: Genetic marker for ankylosing spondylitis. Wikipedia

6. Rheumatoid Factor/Anti-CCP: Support rheumatoid arthritis diagnosis. Wikipedia

Electrodiagnostic Tests

1. Electromyography (EMG): Assesses muscle denervation patterns in L2–L3 myotomes. Wikipedia

2. Nerve Conduction Studies (NCS): Evaluate conduction velocity in peripheral nerves.

3. Somatosensory Evoked Potentials (SSEPs): Test dorsal column integrity.

4. H-Reflex: Analog of the monosynaptic stretch reflex (S1 focus, but can reflect proximal lesions).

5. F-Wave Studies: Assess proximal nerve segment conduction.

6. Motor Evoked Potentials: Via transcranial stimulation to evaluate corticospinal tract.

Imaging Tests

1. Plain Radiographs (AP/Lateral): Initial assessment—look for step-off and grade slip.

2. Flexion-Extension X-Rays: Detect dynamic instability and measure slip change. Radiopaedia

3. Computed Tomography (CT): Detailed bone anatomy; identifies pars defects and facet osteoarthritis.

4. Magnetic Resonance Imaging (MRI): Disc, nerve root, and canal evaluation; detects edema or infection.

5. Bone Scan (99mTc): Highlights increased activity in active spondylolysis or infection.

6. Single-Photon Emission CT (SPECT): Combines CT and bone scan for precise localization of stress reaction.

Non-Pharmacological Treatments

Conservative management is the cornerstone for low-grade posterolisthesis at L2–L3. Clinical guidelines from the North American Spine Society recommend initiating care with non-pharmacological therapies—focusing on pain relief, spinal stabilization, and patient education—before considering invasive options SpinePMC.

A. Physiotherapy & Electrotherapy

1. Transcutaneous Electrical Nerve Stimulation (TENS)

   • Description: Delivers low-voltage electrical currents via skin electrodes.

   • Purpose: Modulates pain signaling by stimulating large-diameter afferent nerves.

   • Mechanism: “Gate control” theory: electrical impulses inhibit nociceptive signals at the spinal cord level Spine-health.

2. Therapeutic Ultrasound

   • Description: High-frequency sound waves applied via a transducer.

   • Purpose: Promotes soft-tissue healing and reduces inflammation.

   • Mechanism: Micro-vibrations increase tissue temperature, enhancing blood flow and collagen extensibility Spine-health.

3. Heat Therapy (Thermotherapy)

   • Description: Application of moist heat packs or heating pads.

   • Purpose: Eases muscle spasm and pain.

   • Mechanism: Vasodilation improves tissue oxygenation and decreases stiffness Spine-health.

4. Cold Therapy (Cryotherapy)

   • Description: Ice packs or cold compression units.

   • Purpose: Reduces acute inflammation and numb superficial pain.

   • Mechanism: Vasoconstriction slows metabolic rate and nerve conduction velocity Spine-health.

5. Electrical Muscle Stimulation (EMS)

   • Description: Delivers pulsed currents to induce muscle contraction.

   • Purpose: Prevents disuse atrophy and promotes muscle strength.

   • Mechanism: Mimics voluntary contraction to improve motor unit recruitment Physiopedia.

6. Shortwave Diathermy

   • Description: High-frequency electromagnetic energy.

   • Purpose: Deep heating of tissues for pain relief and flexibility.

   • Mechanism: Oscillating electromagnetic fields produce heat in deep muscle layers Spine-health.

7. Interferential Current Therapy

   • Description: Two medium-frequency currents that intersect to create a therapeutic low-frequency effect.

   • Purpose: Analgesia and muscle stimulation.

   • Mechanism: Beat frequency enhances depth of penetration, modulating pain pathways Spine-health.

8. Laser Therapy

   • Description: Low-level laser applied to superficial tissues.

   • Purpose: Reduces pain and accelerates healing.

   • Mechanism: Photobiomodulation alters cellular metabolism and decreases inflammatory mediators Spine-health.

9. Traction Therapy

   • Description: Mechanical stretching of the lumbar spine.

   • Purpose: Decompresses intervertebral discs and nerve roots.

   • Mechanism: Reduces disc bulge and opens neural foramina PMC.

10. Manual Therapy (Mobilization/Manipulation)

    • Description: Hands-on joint and soft-tissue techniques.

    • Purpose: Restores joint mobility and decreases pain.

    • Mechanism: Neurophysiological effects modulate pain; mechanical forces alter joint mechanics Physiopedia.

11. Massage Therapy

    • Description: Soft-tissue mobilization by a therapist.

    • Purpose: Relaxes muscles and reduces pain.

    • Mechanism: Mechanical pressure improves circulation and reduces myofascial trigger points Physiopedia.

12. Hydrotherapy

    • Description: Exercises or warm water immersion in a pool.

    • Purpose: Supports body weight, reduces spinal load, and relieves pain.

    • Mechanism: Buoyancy and thermal effects ease movement and muscle tension PMC.

13. Kinesio Taping

    • Description: Elastic tape applied to the skin over muscles and joints.

    • Purpose: Supports soft tissues and may reduce pain.

    • Mechanism: Lifts the skin to improve lymphatic flow and proprioception Physiopedia.

14. Shockwave Therapy

    • Description: Acoustic waves delivered to target tissues.

    • Purpose: Stimulates healing in chronic soft-tissue injuries.

    • Mechanism: Microtrauma triggers neovascularization and tissue regeneration Physiopedia.

15. Biofeedback

    • Description: Visual/auditory feedback of muscle activity.

    • Purpose: Teaches pain coping and muscle relaxation.

    • Mechanism: Enhances voluntary control over muscle tension and pain perception Physiopedia.

B. Exercise Therapies (5 Types)

1. Core Stabilization Exercises
   Strengthening the transverse abdominis and multifidus to support lumbar stability PMC.

2. McKenzie Extension Exercises
   Lumbar extensions to centralize discogenic pain by reducing posterior disc pressure PMC.

3. Williams Flexion Exercises
   Flexion-based movements to open posterior elements and relieve facet stress PMC.

4. Aerobic Conditioning (Walking)
   Low-impact cardiovascular activity to maintain general fitness and spinal nutrition PMC.

5. Pilates-Based Exercise
   Controlled movements emphasizing core control and postural alignment PMC.

C. Mind-Body Therapies

1. Cognitive Behavioral Therapy (CBT)
   Addresses pain perception and coping strategies PMC.

2. Mindfulness Meditation
   Promotes non-judgmental awareness of pain sensations PMC.

3. Yoga
   Combines gentle stretching with mindfulness for flexibility and stress reduction PMC.

4. Tai Chi
   Slow, flowing movements enhance balance and reduce pain sensitivity PMC.

5. Guided Imagery
   Uses mental visualization to modulate pain pathways PMC.

D. Educational Self-Management

1. Pain Education Programs
   Teaching the neuroscience of pain to reduce fear and improve coping PMC.

2. Back School
   Structured sessions on spine anatomy, posture, and safe movement PMC.

3. Ergonomic Training
   Adjusting workstations and daily activities to minimize spinal load PMC.

4. Activity Pacing
   Balancing rest and activity to prevent flare-ups PMC.

5. Goal Setting & Self-Monitoring
   Using diaries and SMART goals to track progress and encourage self-efficacy PMC.

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Pharmacological Treatments

Medication can complement conservative care by targeting pain, inflammation, muscle spasm, and neuropathic symptoms. Guidelines from the American College of Physicians recommend a stepped approach—starting with acetaminophen or NSAIDs, then adding adjuncts as needed AAFP.

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Dietary Molecular Supplements

Supplements may offer adjunctive support for disc health and inflammation. Evidence is mixed; always consult a clinician before use.

1. Glucosamine Sulfate

   • Dosage: 1500 mg once daily.

   • Function: Cartilage precursor, may support intervertebral disc matrix.

   • Mechanism: Provides substrates for glycosaminoglycan synthesis; anti-inflammatory effects DrugBankAAFP.

2. Chondroitin Sulfate

   • Dosage: 800–1200 mg daily.

   • Function: Structural component of cartilage and discs.

   • Mechanism: Stimulates proteoglycan and hyaluronic acid synthesis; inhibits catabolic enzymes Wikipedia.

3. Methylsulfonylmethane (MSM)

   • Dosage: 1500–3000 mg daily.

   • Function: Anti-inflammatory and antioxidant.

   • Mechanism: Reduces pro-inflammatory cytokines (TNF-α, IL-1β) and oxidative stress PMCWikipedia.

4. Curcumin (Turmeric Extract)

   • Dosage: 500–1000 mg standardized extract daily.

   • Function: Potent anti-inflammatory.

   • Mechanism: Inhibits NF-κB and COX-2 pathways Verywell Health.

5. Omega-3 Fatty Acids (EPA/DHA)

   • Dosage: 1000–3000 mg fish oil daily.

   • Function: Reduces inflammation and may support nerve health.

   • Mechanism: Precursor to anti-inflammatory resolvins and protectins Verywell Health.

6. Vitamin D₃

   • Dosage: 800–2000 IU daily.

   • Function: Bone and muscle health.

   • Mechanism: Regulates calcium homeostasis and muscle function Verywell Health.

7. Magnesium

   • Dosage: 300–400 mg daily.

   • Function: Muscle relaxation and nerve conduction.

   • Mechanism: Cofactor for ATPase pumps regulating muscle contractility Verywell Health.

8. Type II Collagen

   • Dosage: 40 mg daily.

   • Function: May support cartilage and disc integrity.

   • Mechanism: Oral tolerance induction modulating immune response against joint tissues Verywell Health.

9. Hyaluronic Acid (Oral/Injection)

   • Dosage: 50–200 mg oral or 1–2 mL injection per joint.

   • Function: Improves lubricity of synovial fluid.

   • Mechanism: Binds water, enhances viscoelasticity of extracellular matrix Verywell Health.

10. Boron (Calcium Fructoborate)

    • Dosage: 3–6 mg boron daily.

    • Function: Bone metabolism and anti-inflammatory.

    • Mechanism: Modulates steroid hormones and inflammatory cytokines Verywell Health.

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Advanced Biologic & Bone-Targeted Drugs

Emerging therapies aim to modify disease progression or regenerate tissues Caring Medical.

1. Alendronate (Bisphosphonate) – 70 mg once weekly; inhibits osteoclasts to improve bone density.

2. Risedronate – 35 mg once weekly; similar anti-resorptive effect.

3. Zoledronic Acid – 5 mg IV yearly; potent bisphosphonate.

4. Denosumab – 60 mg SC every 6 months; anti-RANKL monoclonal antibody.

5. Platelet-Rich Plasma (PRP) – autologous injection; growth factors promote healing.

6. Autologous Conditioned Serum – IL-1 receptor antagonist injection; reduces inflammation.

7. Hyaluronic Acid Injection – 1–2 mL per joint; improves lubrication.

8. Bone Morphogenetic Protein-2 (BMP-2) – 1.5 mg/cc; stimulates osteogenesis in fusion procedures.

9. Mesenchymal Stem Cell Therapy – 1–2 × 10⁶ cells; potential disc regeneration.

10. Autologous Bone Marrow Aspirate Concentrate – cell therapy with progenitor cells for repair.

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Surgical Procedures

Surgery is reserved for persistent pain or neurological compromise.

1. Posterolateral Fusion (PLF)

   • Procedure: Decortication of transverse processes with bone graft.

   • Benefits: Stabilizes slip, reduces motion-related pain.

2. Posterior Lumbar Interbody Fusion (PLIF)

   • Procedure: Removal of disc and insertion of cage grafts via posterior approach.

   • Benefits: Restores disc height and foraminal space.

3. Transforaminal Lumbar Interbody Fusion (TLIF)

   • Procedure: Posterior approach through one side of the spinal canal, cage insertion.

   • Benefits: Less neural retraction than PLIF.

4. Anterior Lumbar Interbody Fusion (ALIF)

   • Procedure: Access disc space via an abdominal approach, insert graft.

   • Benefits: Preserves posterior elements; good disc height restoration.

5. Lateral Lumbar Interbody Fusion (LLIF/XLIF/OLIF)

   • Procedure: Lateral retroperitoneal approach, cage insertion.

   • Benefits: Minimally invasive, fewer blood loss.

6. Decompressive Laminectomy

   • Procedure: Removal of lamina to relieve neural compression.

   • Benefits: Rapid pain relief from nerve decompression.

7. Interspinous Process Spacer

   • Procedure: Implant between spinous processes to offload facets.

   • Benefits: Motion preservation, minimally invasive.

8. Dynamic Stabilization (e.g., Dynesys)

   • Procedure: Non-rigid pedicle screw–based system.

   • Benefits: Maintains some segmental motion.

9. Facet Joint Fusion

   • Procedure: Grafting of facet joints posteriorly.

   • Benefits: Additional posterior stability.

10. Minimally Invasive Transsacral Interbody Fusion (AxiaLIF)

    • Procedure: Percutaneous approach through sacrum to L5–S1.

    • Benefits: Less muscle disruption.

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Prevention Strategies

1. Maintain a healthy body weight to reduce spinal load.

2. Practice proper lifting (bend knees, keep spine neutral).

3. Stop smoking to preserve bone and disc health.

4. Strengthen core musculature with regular exercise.

5. Use ergonomic chairs and take regular breaks if seated.

6. Wear supportive footwear to optimize posture.

7. Avoid prolonged static postures; stand and stretch hourly.

8. Ensure adequate calcium and vitamin D intake.

9. Incorporate low-impact aerobic activity (swimming, walking).

10. Attend back-school education for posture and body mechanics.

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When to See a Doctor

• Severe or progressive neurological deficits: new weakness or numbness in legs

• Cauda equina signs: saddle anesthesia, bowel/bladder dysfunction

• Unrelenting night pain or weight loss (rule out infection/tumor)

• Fever with back pain (possible spinal infection)

• History of significant trauma to the spine

• No improvement after 6–12 weeks of conservative treatment

• Intractable pain preventing daily activities

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“Do’s” and “Don’ts”

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Frequently Asked Questions

1. What exactly is L2–L3 posterolisthesis?
   It is a backward slip of L2 on L3, which may narrow nerves and cause low back pain MedicineNet.

2. How is posterolisthesis different from spondylolisthesis?
   Posterolisthesis (retrolisthesis) is backward slip; spondylolisthesis typically refers to forward slip (anterolisthesis) NCBI.

3. What grades are used?
   Graded I–IV based on the percentage of posterior displacement relative to vertebral width MedicineNet.

4. What symptoms does it cause?
   Lower back pain, stiffness, nerve pain radiating to legs, weakness, numbness, and reduced spinal mobility Cleveland Clinic.

5. How is it diagnosed?
   Lateral lumbar X-rays show posterior slip; MRI evaluates disc and neural structures MedicineNet.

6. Can non-surgical treatments cure it?
   Many low-grade cases improve with physiotherapy, exercise, and medications; surgery reserved for refractory or neurologic deficits PMC.

7. Are braces helpful?
   A temporary lumbar support can reduce motion and pain but should be combined with active therapy PMC.

8. Is core strengthening important?
   Yes—strong core muscles support the spine, decrease shear forces, and reduce pain PMC.

9. What lifestyle changes help?
   Weight loss, smoking cessation, ergonomic adjustments, and regular low-impact exercise Cleveland Clinic.

10. When is surgery indicated?
    Progressive neurologic deficits, intractable pain despite 6–12 weeks of conservative care, or severe mechanical instability PMC.

11. What is the recovery after fusion surgery?
    Initial 6 weeks of limited activity, gradual return to light work by 3 months, full fusion by 6–12 months PMC.

12. Can supplements replace medications?
    Supplements may support joint health but do not replace evidence-based pharmacotherapy AAFP.

13. Are epidural steroid injections effective?
    They can provide temporary relief for nerve root irritation but effects often last 3–6 months PMC.

14. Is retrolisthesis progressive?
    Low-grade slips often remain stable; progression depends on underlying degeneration and activity level PubMed.

15. Can children get posterolisthesis?
    Rarely; pediatric cases usually result from trauma or congenital anomalies rather than degeneration NCBI.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members

Last Updated: May 21, 2025.

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