Lordosis: Spondylolysis and Spondylolisthesis Flashcards Preview

Spinal Conditions > Lordosis: Spondylolysis and Spondylolisthesis > Flashcards

Flashcards in Lordosis: Spondylolysis and Spondylolisthesis Deck (7)
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Surgical Intervention


Indications: persistent back pain despite conservative measures, gait deviations, greater than 50% slippage, marked instability, neurologic deficit/radiculopathy, hamstring contracture

Goals: Prevent further slippage, immobilization of unstable segment, prevention of further neuro deficit, relieve nerve root irritation, correct clinical symptoms of poor posture, gait, and decreased hamstring length

Surgical Approaches:

  • Posterolateral arthrodesis
  • Anterior arthrodesis
  • decompression- performed when there is neuro deficit
  • reduction and instrumentation- performed when the sacrum is in a vertical position resulting in severe lumbosacral kyphosis that displaces lumbar spine anteriorly—results in compensatory lumbar lordosis
  • fusion extends from L4-S1 performed with iliac bone graft

Nonsurgical Intervention


Observation = Rx of choice with asymptomatic low grade spondylolisthesis ( < 50% slippage)

Routinely followed 2 x/year with clinical and xray exam

Symptomatic spondylolysis or low grade spondylolisthesis respond well to activity restriction, PT, and spinal bracing

PT: lumbar stabilization exercises, strength training of TA, multifidus, and internal oblique
- incorporate co contraction of stabilizers into functional activities to support lumbar spine and decrease LBP

Immobilization with TLSO

  • indicated when stress fx of pars or well-defined spondylitic defect
  • wear ranges from 6-12 weeks, may continue up to 6 months

Return to Play: painless spinal mobility, resolved hamstring spasm/contracture, return to activities without pn

Surgery indicated if symptoms persist


Risk of Progression


Low risk of progression in spondylolysis and spondylolisthesis, < 3%

Adolescents who are asymptomatic = higher risk of slippage during growth spurt

  • females at greater risk than males
  • patients with lig laxity also at risk (DS, marfan’s)

Risk for increased slippage:

  • 50% slippage
  • slip angle greater than 55d in skeletally immature
  • bony instabilities or decrease anatomic stability of L5-S1

Clinical Symptoms


Mild Slippage- poor posture, increased lumbar lordosis

High grade slippage- flattened lumbar spine, vertically oriented sacrum, visible and palpable step off at involved level

Symptoms: LBP relieved by rest, sciatic type pn, hamstring spasm or tightness
– severe cases- torso shortening


Types of Spondylolysis and Spondylolisthesis

- Dysplastic and Isthmic m/c in peds

  1. Dysplastic - secondary to congenital malformations of sacrum and posterior arch of L5
    - - Malformations include: hypoplasia of superior S1, hypoplasia of facts, elongation of pars, spina bifida
    - - Malformations decrease stability
    - - Degree of slippage usually severe with neuro deficits
  2. Isthmic- slip secondary to elongation of pars, break in pars, or combo of both with facets intact
    - - stress fx
    - - elongation occurs d/t result of repeated microfx that heal the pars in elongated position
    - - may also occur d/t acute fx of pars
  3. Degenerative- older adults ( > 50y/o), structural destruction of capsules and ligs of posterior joints resulting in hypermobility of segment
  4. Traumatic- fracture of posterior arch, may occur at pedicle, laminae, or facet, leaving pars intact
  5. Pathologic- occurs secondary to infectious disease that destroys posterior arch of vertebrae

Spondylolysis (pars fx)

Spondylolisthesis (pars fx with slippage)


Cause: genetic predisposition, sports with repetitive hyperextension and rotational loading (gymnastics, diving)

Spondylolisthesis- usually occurs at 5th vertebrae, anterior slippage


Spondylolisthesis Grades


I: Mildest, less than 25% slip
II: 25-50% slip
III: 50-75% slip
IV: greater than 75% slip