- Discussion:
- those w/ symptomatic Grade II spondylolithesis should be restricted from activities such as gymnastics;
- in younger children (ages 6 to 12), a slip of this degree is significant and highly likely to progress during the remaining growth years;
- fusion should thus be done, even if the patient has no symptoms;
- slip in a mature adolescent have a smaller risk of progression is far less;
- symptomatic slips of 25-50 % should be fused, but asympotmatic can be periodically checked;
- risk of progression:
- young age at presentation, female sex;
- slip angle > 10 deg (angle formed by intersection of lines parallel to inferior border of body of L5 & top of sacrum on lateral x-ray);
- high grade slip;
- domed shaped or significantly inclined sacrum (> 30 deg beyond vertical);
- Exam:
- Non Operative Treatment:
- majority of pts w/ symp. spondylolisthesis respond to conservative rx;
- orthosis can be used as adjunct to conservative care based upon duration and severity of symptoms.
- Operative Treatment:
- if non-op measures fail & operative treatment is indicated, bilateral arthrodesis of lateral column or transverse process is preferred;
- posterior spine fusion is limited to those pts who do not respond to conservative measures & for those whose slip is greater than 50%;
- fusion is performed to prevent total spondyloptosis;
- L5 to S1 fusion is usually adequate;
- in pts who have Grade-I or II spondylolisthesis, body of fifth lumbar vertebra is not usually tilted, and arthrodesis of the transverse
processes of 5th lumbar vertebra to ala of the sacrum is sufficient;
- indications for reduction of slip are not clear at this time;
- anterior & posterior fusions are carried out when slip is severe and associated w/ marked lumbosacral kyphosis
Brace treatment for symptomatic spondylolisthesis.