- Types of Spondylolisthesis:
-
Congenital
-
Isthmic
-
Degenerative
-
Spondylolysis of the Fourth Lumbar Vertebra
-
Spondylolisthesis w/ Scoliosis
- Discussion:
- spondylolysis involves defect passing between superior articular process & remainder of the lamina, most often involving L5;
- when condition is bilateral, superior articular processes are attached to the body by pedicles, but most of the lamina, spinous process, and inferior articular processes are detached;
- as consequence of defect, body of involved vertebra may displace anteriorly (spondylolisthesis).
-
scoliosis is common w/ spondylolysis but herniation of the nucleus pulposus rarely accompanies spondylolisthesis in children;
-
diff dx:
- Exam:
- Radiographs:
- x-rays are taken in the stading position to accentuate slippage;
-
Grade I:
(see:
occult spondylysis)
-
Grade II:
-
Grade III and IV:
-
Slip Angle;
-
Bone Scans
- Treatment:
-
Grade I:
-
Grade II:
- surgery is reserved for patients w/ intractable pain who have failed non-operative treatment, or w/ progressive deformity;
- treatment involves L5-S1 posterolateral fusion in situ;
-
Grade III and IV:
- treatment involves arthrodesis from L4 to S1;
-
Reduction:
- Decompression:
- as noted by Carragee, 1997, the addition of decompression to the posterolateral arthrodesis may actually increase the rate
of pseudoarthrosis and the rate of clinical failure;
- reference:
- Single level posterolateral arthrodesis, with or without posterior decompression, for the treatment of isthmic spondylolisthesis in adults. A prospective randomized trial.
EJ Carragee.
JBJS. Vol 79-A. No 8. Aug 1997. p 1175.
- References:
