Spondylolysis & Spondylolisthesis

Question 1

Define sponylolysis.

Answer 1

A fracture in the pars interarticularis (a bone connecting one facet joint to another) where the vertebral body and the posterior elements protecting the nerves are joined. In a small percent of the adult population, there is a developmental crack in one of the vertebrae, usually at L5

Question 2

Define spondylolisthesis.

Answer 2

Spondylolisthesis refers to slippage of a vertebral body over another, usually with the superior vertebral body slipping anteriorly relative to an adjacent inferior vertebral body (anterolisthesis). Can cause spinal stenosis.

Question 3

Define spondylosis.

Answer 3

Arthritis of the spine. Seen radiographically as disc space narrowing and arthritic changes of the facet joint.

Question 4

Define spinal stenosis.

Answer 4

Local, segmental, or generalized narrowing of the vertebral canal by bone or soft tissue elements, usually bony hypertrophic changes in the facet joints and by thickening of the ligamentum flavum.

Question 5

Define radiculopathy.

Answer 5

Impairment of a nerve root, usually causing radiating pain, numbness, tingling, or muscle weakness that corresponds to a specific nerve root.

Question 6

Summarise the causes of low back pain.

Answer 6

Question 7

What serious causes must be exclude in back pain?

Answer 7

Spinal cord or cauda equina compression
Metastatic cancer
Spinal infection (spinal epidural abscess or vertebral osteomyelitis)

Question 8

What are some presenting features of spondylolithesis and spondylolysis?

Answer 8

Features of spinal stenosis:

• Back pain which resolves on sitting or leaning forward
• Sensory loss
• Weakness in legs
• Neurogenic claudication - i.e. also increased with walking but relieved on walking flexed with cart and not relieved on standing still.

Question 9

What is the management of spinal stenosis?

Answer 9

Conservative:

• Physiotherapy - stretching, strengthening and aerobic fitness are recommended
• Weight loss if overweight

Medical

• Analgesia
• NSAIDs
• Epidural steroid injections - glucocorticoid and lidocaine
• NB: pregabalin has not been found to be effective

Surgical

• Decompressive laminectomy +/- lumbar fusion - lumbar fusion is generally reserved for patients with spondylolisthesis
• Intraspinous spacer implantation - for those without spondylolisthesis

Question 10

What is shown ?

Answer 10

Interspinous spacer implantation

Question 11

When do you consider referral for spinal surgery in spondylolysis/sponylolisthesis?

Answer 11

Any signs of neurologic injury, including lumbosacral radiculopathy or any other abnormal neurologic findings

Question 12

What is the management of spondylolysis/ spondylolisthesis?

Answer 12

1. Exclude any red flags
2. Analgesia
3. 2-4 weeks rest
4. Plain XR of spine
5. Physiotherapy
6. Above grade 1 spondylolisthesis -> refer to orthopaedic surgeon