Isthmic Spondylolisthesis



- Discussion:
    - most common type seen in children & young adults;
    - occurs in about 5% of the population;
           - more common in Eskimos;
           - more common in yound white males involved in  hyperextension activities;
    - most common at ages 5-8 years;
    - results from shear stress at pars intra-articularis, and is more common in repetitive hyperextension activities;
    - associated conditions:
           - spina bifida occulta;
                  - those w/ more severe degrees of slipping early in life are most oftenfemale, and it is most often associated w/ Spina Bifida 
                          occulta and L5 to S1;
           - thoracic kyphosis;
           - Scheuermann's disease;

- Clinical Manifestations:
    - usually at L5-S1, usually presents w/ back pain (instability), deformities
          or alteration in gait "pelvic waddle" & hamstring spasm;
    - Kyphosis of lumbosacral junction w/ or w/o palpable step off;
    - severe slips may be assoc w/ radicular findings (L5);
          - this occurs from compression between the superior end plate of the caudad vertebrae and the inferior facet of the cephalad vertebrae
                 
- Radiographs:
    - Grade I:
    - Grade II:
    - Grade III and IV:

- Treatment:
    - although most patients will develop isthmic spondylolithesis in childhood and adolescence, most patients (90%) who require 
          surgery are adults;
    - treatment is based on grade (I, II, III and IV) and clinical findings;
          - w/ high grade L5-S1 slip consider additional fusion to L4-5 (especially if MRI shows L4-L5 disc degeneration);
          - wide neuroforaminal decompression is also usually required;

- Gill Procedure:
    - of historical interest;
    - involves removal of the loosely attached arch of L5;
    - procedure was complicated by recurrence of pain and progression of deformity



Natural history of symptomatic isthmic low-grade spondylolisthesis in children and adolescents: a seven-year follow-up study.

Isthmic spondylolisthesis in symptomatic and asymptomatic subjects, epidemiology, and natural history with special reference to disk abnormality and mode of treatment.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, December 21, 2011 1:47 pm