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PubMed2026

The prevalence of isthmic and degenerative lumbar spondylolisthesis: an analysis of 1376 patients.

INTRODUCTION: Typically, spondylolisthesis is an asymptomatic spinal condition that is often captured accidently in radiographic studies. The limited studies reviewing incidence primarily used lateral radiographs, which lack the granularity of advanced imaging. In response, computed tomography (CT) has been recommended to enhance the accuracy of spondylolisthesis diagnosis (degenerative versus isthmic). In the present study, we sought to determine the prevalence of isthmic and degenerative spondylolisthesis using CT imaging. METHODS: We conducted a retrospective study of 1,680 patients who underwent abdominal/pelvic CT scans at a single level-1 trauma center from January 1, 2017, to January 31, 2017. RESULTS: A total of 1,680 CT scans were screened, of which 1,376 patient scans met the inclusion criteria of having undergone complete imaging (axial and sagittal images). The average age of the study population was 57.1 (standard deviation, 18.7) years; 51.1% were female, and 83.2% were Caucasian. The prevalence of isthmic spondylolisthesis was 5.4% (n = 71): 3.6% of cases were at the L5-S1 level, 2.1% were at the L4-L5 level, and 0.6% were at the L3-L4 level. The female-to-male ratio was 0.73:1. The prevalence of degenerative spondylolisthesis was higher at 21.5% (n = 285), and the level most commonly affected was L4-L5 (11.8%), followed by L5-S1 (9.7%) and L3-L4 (4.6%). The female-to-male ratio was 1.3:1. There was a higher prevalence of degenerative spondylolisthesis in women at L4-L5 (51.2% vs. 35.6%; P < 0.001). CONCLUSION: We found that degenerative spondylolisthesis was more prevalent, occurring primarily in older women, between the L4-L5 vertebrae. On the other hand, isthmic spondylolisthesis more commonly occurred within male patients between the L5-S1 vertebrae. Our study is one of the first to recognize a high rate of degenerative spondylolisthesis within the L5-S1 region, highlighting the utility of CT scan to visualize spinal translation. LEVEL OF EVIDENCE: IV.

Humans↗

PubMed2001

Global spinal motion in subjects with lumbar spondylolysis and spondylolisthesis: does the grade or type of slip affect global spinal motion?

STUDY DESIGN: This was a prospective pilot study to investigate the global motion characteristics of the spondylolysis and spondylolisthesis populations. OBJECTIVES: The aim of this study is to determine the influence of a spondylolisthesis or a spondylolysis on global spinal motion and to establish whether this is dependent on the cause of the slip or the degree/grade of the slip. SUMMARY OF BACKGROUND DATA: The condition of spondylolisthesis has been extensively discussed in the literature with respect to its etiology and management. However, the mechanics and movement of the spine in relation to pathology and the effect of this condition on function have received scant attention. METHODS: The motion of the lumbar spine was investigated in 31 patients (19 men, 12 women, mean age 47.7 +/- 17.8 years) who were diagnosed as having either a lumbar spondylolysis or a spondylolisthesis. These patients were compared with a preexisting database of 203 normal subjects (100 men, 103 women, mean age 39.8 +/- 13.4 years). Patients were graded according to the type of spondylolisthesis or spondylolysis they had, and the extent of slip was rated using Meyerding's classification (1932) and measured directly using methods of Boxall et al (1979) and Wiltse et al (1983). RESULTS: Direct measurements of the extent of slip using Boxall et al (1979) and Wiltse et al (1983) methods were found to have no significant correlation with the resultant range of motion (ROM) or the speed of movement. This study suggests that motion parameters are influenced by the grade of slip in patients with spondylolisthesis, and the type of spondylolisthesis i.e., whether isthmic or degenerative. In the A-P flexion-extension plane, the results indicate that subjects with a defect only, i.e., a spondylolysis, and thus no slip present with a spinal hypermobility (P < 0.01). Subjects with an isthmic slip tend to be either slightly hypermobile or within the anticipated range of motion, whereas those subjects with a degenerative slip tend to be hypomobile (P < 0.05). Movements into lateral flexion were restricted in both the isthmic and degenerative spondylolisthesis patients, whereas rotation was only influenced by the level at which the defect occurred. In terms of degree of displacement, in higher grades of displacement, there was a trend towards hypermobility. CONCLUSIONS: The findings of this study suggest that the grade and type of spondylolisthesis do influence global motion parameters. This information may be useful in the clinical assessment of this patient group.

Adult↗

PubMed2004

Spondylolisthesis, pelvic incidence, and spinopelvic balance: a correlation study.

STUDY DESIGN: A retrospective study of the sagittal alignment in developmental spondylolisthesis. OBJECTIVES: To investigate the role of pelvic anatomy and its effect on the global balance of the trunk in developmental spondylolisthesis. SUMMARY OF BACKGROUND DATA: Pelvic incidence (PI) is a fundamental anatomic parameter that is specific and constant for each individual, and independent of the three-dimensional orientation of the pelvis. Recent studies have suggested an association between a high PI and patients with isthmic spondylolisthesis. METHODS: The lateral standing radiographs of the spine and pelvis of 214 subjects with developmental L5-S1 spondylolisthesis were analyzed with a dedicated software allowing the calculation of the following parameters: pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), and grade of spondylolisthesis. All measurements were done by the same individual and compared to those of a cohort of 160 normal subjects. Student's tests were used to compare the parameters between the curve types and Pearson's correlation coefficients were used to investigate the association between all parameters (alpha = 0.01). RESULTS: PI, SS, PT, and LL are significantly greater (P < 0.01) in subjects with spondylolisthesis, while TK is significantly decreased. PI has a direct linear correlation (0.41-0.65) with SS, PT, and LL. Furthermore, the differences between the two populations increase in a direct linear fashion as the severity of the spondylolisthesis increases. CONCLUSIONS: Since PI is a constant anatomic pelvic variable specific to each individual and strongly determines SS, PT, and LL, which are position-dependent variables, this study suggests that pelvic anatomy has a direct influence on the development of a spondylolisthesis.Study participants with an increased pelvic incidence appear to be at higher risk of presenting a spondylolisthesis, and an increased PI may be an important factor predisposing to progression in developmental spondylolisthesis.

Adolescent↗

PubMed1987

Foraminal encroachment syndrome in true lumbosacral spondylolisthesis: a preliminary report.

The source of pain in isthmic spondylolisthesis is uncertain. Some authors believe that spondylolysis and/or spondylolisthesis is not a predisposing factor to low back pain and that the mere presence of isthmic spondylolisthesis may, indeed, not be the cause of low back pain in the patient. This study explores a possible source of biomechanical dysfunction as an origin of pain in isthmic spondylolisthesis. One hundred and twenty lumbar intervertebral disc angles were measured, 60 of which had spondylolisthesis and the remaining 60 without spondylolisthesis for comparison of the effect that spondylolisthesis has on intervertebral disc angulation of the lumbar spine. The results reveal that the L4-L5 joint has the greatest biomechanical stress placed upon it by virtue that it had the highest intervertebral disc angulation when the component of spondylolisthesis was a factor at L5-S1. Therefore, due to increased intervertebral disc angles at L4-L5, a biomechanical stressing and resulting hyperextension of the facet articulation at L4-L5 may represent a source of symptomatology in isthmic spondylolisthesis of L5-S1.

Adolescent↗

PubMed1997

Spondylolisthesis in the elite football player: an epidemiologic study in the NCAA and NFL.

Although spondylolisthesis in and of itself is not a contraindication to participation or successful performance in football, having spondylolisthesis may well predispose to symptoms and be associated with a worse prognosis. The purpose of this study was to determine the reported prevalence, treatment approach, outcomes, and perceptions regarding prognosis of elite football players with spondylolisthesis by their National Collegiate Athletic Association (NCAA) and National Football League (NFL) team physicians. A questionnaire regarding the prevalence, treatment, results, and perceptions regarding prognosis related to spondylolisthesis in football players was submitted to each team orthopaedic surgeon of the 28 NFL and the Final Associated Press ranked top-25 NCAA Division I teams at the conclusion of the 1993-1994 season. All questionnaires were returned for review. The prevalence of players with known spondylolisthesis currently participating in elite football was 1% in both the NCAA and NFL. Fifty-two percent of NCAA and 43% of NFL team physicians were aware of at least one athlete with spondylolisthesis currently playing. Only six college and two NFL team physicians were aware of athletes surgically treated for spondylolisthesis. Sixty-four percent of NFL team physicians and 36% of college team physicians believed that the presence of spondylolisthesis implies a poor prognosis. Ninety-six percent of professional team physicians downgraded the rating of players with known spondylolisthesis before the NFL draft.

Adult↗

PubMed2001

Osteoporotic spondylolisthesis: a case report.

STUDY DESIGN: A case of spondylolisthesis caused by osteoporosis is described. OBJECTIVES: To describe the different etiologies of spondylolisthesis, and to report a new cause of pathologic spondylolisthesis previously unreported in the literature. SUMMARY OF BACKGROUND DATA: The literature on the etiology of spondylolisthesis is reviewed. Pathologic spondylolisthesis has been described with structural abnormalities, such as Paget's disease and tumors, but not with osteoporosis. METHODS: A clinical and radiographic interpretation of the reported case is presented. RESULTS: De Novo development of a spondylolisthesis at L5-S1 occurred by gradual elongation of the pars interarticularis over a period of 3 years. CONCLUSION: The reported case adds to the literature on spondylolisthesis by describing another etiology for this conclusion. Osteoporotic spondylolisthesis may well be identified more frequently in the future given the high prevalence of osteoporosis in the elderly.

Aged↗

PubMed2001

Spondylolisthesis in osteogenesis imperfecta due to pedicle elongation: report of two cases.

STUDY DESIGN: Two cases of spondylolisthesis due to severe elongation of pedicles in osteogenesis imperfecta are reported. OBJECTIVE: To describe an unusual type of spondylolisthesis and its successful management. SUMMARY OF BACKGROUND DATA: Spondylolisthesis is known to occur in osteogenesis imperfecta. Reports in the literature are few. Pedicle elongation resulting in spondylolisthesis has only been reported once. There is no report of a successful treatment of this type of spondylolisthesis resulting from pedicle elongation. METHOD: Two adolescent girls suffering from osteogenesis imperfecta presented with lower back pain and thoracic scoliosis. One of them had high-grade spondylolisthesis of L3-L4, L4-L5, and L5-S1, with a thoracic scoliosis. She was treated with anterior interbody fusion L3 to sacrum without instrumentation. Later, progression of her scoliosis required combined anterior and posterior instrumented fusion T1 to L1. The other girl presented with L5 spondylolisthesis and thoracic scoliosis. She has back pain as well as neurologic symptoms in her legs and is waiting for surgery. RESULTS: At the 3-year follow-up the operated patient is symptom-free from her spine and there has been no progression of either deformity. CONCLUSION: High-grade spondylolisthesis due to elongation of pedicle in osteogenesis imperfecta is uncommon. Anterior interbody fusion of all the involved motion segments has produced good pain relief and arrested deformity progression at the 3-year follow-up.

Adolescent↗

PubMed2002

Radiographic markers in spondyloptosis: implications for spondylolisthesis progression.

STUDY DESIGN: Radiographic analysis of spinopelvic morphology and posterior element dysplasia in spondyloptosis. SUMMARY OF BACKGROUND DATA: Spondylolisthesis treatment protocols are based on age, symptomatology, and slippage degree. Spinopelvic morphology and dysplasia can determine progression. Frequency of two denominators of high-grade spondylolisthesis-degree of dysplasia and spinopelvic morphology-is unknown. OBJECTIVES: To determine common radiographic denominators of spondyloptosis-degree of posterior bony hook dysplasia and spinopelvic morphology-as prognostic factors for spondylolisthesis progression. METHODS: Patients with spondyloptosis were reviewed. Bony dysplasia at lumbosacral junction was graded. Pelvic incidence and sacral kyphosis were measured. RESULTS: A total of 53 patients had a mean sacral kyphosis of 56 degrees and pelvic incidence of 76 degrees; 62% of patients had posterior element dysplasia. CONCLUSION: Prognostic factors for spondylolisthesis progression, such as percent of slippage, do not identify lower-grade slips at risk for progression. Progression is linked to increased shear stress across the lumbosacral junction and inability to resist it. Increased stress is related to increased verticality of the lumbosacral joint, which is individually predetermined by pelvic incidence and sacral anatomy. Pelvic incidence is fundamental in determining sagittal spine curvature required for economic spinopelvic balance. Pelvic incidence is independent of adaptive changes in higher-grade spondylolisthesis. Pelvic incidence in our spondyloptosis series (76 degrees) is higher than in normal (48.2-53.2 degrees ) and low-grade spondylolisthesis (64.5 degrees). Posterior element dysplasia decreases mechanical resistance to lumbosacral shear stress. Incidence of dysplasia in our series (62%) is higher than that reported in low-grade spondylolisthesis. Analysis of pelvic incidence and posterior element dysplasia may aid in estimation of risk for progression of spondylolisthesis.

Adolescent↗

PubMed2003

Vertical instability in spondylolisthesis: a traction radiographic assessment technique and the principle of management.

STUDY DESIGN: Lateral radiographs of the lumbar spine were taken of 40 patients with lumbar spondylolisthesis. These radiographs were taken in the neutral, flexion, and extension positions for both erect and recumbent postures, and also in the prone and supine positions with traction applied via a traction table. OBJECTIVES: To define and demonstrate the presence of "vertical instability" in spondylolisthesis, and to determine the most useful radiographic views for clinical purposes and analysis of the surgical principle. SUMMARY OF BACKGROUND DATA: Lateral radiographs of patients in flexion and extension are widely used to obtain quantitative and qualitative data on lumbar spondylolisthesis. Changes in lumbar disc height and segmental translation in a group of patients with spondylolisthesis have been demonstrated with the addition of traction and compression. METHODS: Lateral and flexion extension radiographs of the lumbosacral spine in 37 patients with spondylolisthesis taken in standing and recumbent positions and under pelvic traction in the prone or supine positions were suitable for analysis. The changes in disc area, intervertebral kyphotic slip angle, and amount of anteroposterior shift (olisthesis) were measured from the radiographs using a computer digitizer. The disc area was normalized against the area of the superior vertebra, and the amount of anteroposterior shift was normalized against the anteroposterior width of the superior vertebra. Inter- and intraobserver error was found to be negligible, and results were analyzed by paired t test. RESULTS: Maximum slip angle, maximum olisthesis, and minimum normalized disc area were found with the subject under erect flexion. Conversely, prone traction and recumbent extension produced minimum slip angle, whereas the lowest anteroposterior shifts were seen with the subject under prone and supine traction. Prone traction also resulted in a significantly larger normalized disc area than any other posture. The change in kyphotic slip angle between erect flexion and prone traction is correlated with the change in normalized olisthesis and disc area. CONCLUSIONS: Erect flexion and prone traction radiographs represent the extremes of subluxation and reduction of the olisthesis, respectively, and the change in olisthesis seen between these extremes is correlated with the change in disc area and the intervertebral slip angle. Vertical laxity of the affected functional spinal unit resulting from disc degeneration produces laxity in the ligaments and disc anulus, allowing olisthetic motion. Restoration of disc height in turn restores tension to the soft tissues around the disc and results in a spontaneous reduction of the subluxation. Restoration and maintenance of disc height with a spacer or interbody fusion therefore is recommended as a goal in the treatment of spondylolisthesis. When spondylolytic spondylolisthesis involves a posterior column deficiency, additional reconstruction of this column with posterior instrumentation is recommended. Application of the traction radiographic technique in planning for spondylolisthesis reduction is discussed along with the technique of stabilization.

Adolescent↗

PubMed2005

The importance of spino-pelvic balance in L5-s1 developmental spondylolisthesis: a review of pertinent radiologic measurements.

STUDY DESIGN: A review article. OBJECTIVES: The purpose of this article is to review pertinent radiologic measurements for the evaluation of spino-pelvic balance in developmental spondylolisthesis, based on the experience of the Spinal Deformity Study Group. SUMMARY OF BACKGROUND DATA: Over the past decade, pelvic morphology has been shown to significantly influence spino-pelvic balance of the human trunk in normal and pathologic conditions. This finding has important implications for the evaluation and treatment of developmental spondylolisthesis and has fostered a renewed interest in the radiologic evaluation of spino-pelvic balance in this condition. METHODS: The lateral standing radiographs of the spine and pelvis of subjects with developmental L5-S1 spondylolisthesis were analyzed with a dedicated software allowing the calculation of the following parameters: pelvic incidence, sacral slope, pelvic tilt, L5 incidence angle, lumbosacral angle, lumbar lordosis, thoracic kyphosis, and grade of spondylolisthesis. All measurements were done by the same individual and compared to those of an adult and child reference population. RESULTS: The pelvic shape, best quantified by the pelvic incidence angle, determines the position of the sacral endplate. The spine reacts to this position by adapting through lumbar lordosis, the amount of lordosis increasing as the sacral slope increases in order to balance the trunk in the upright position. Pelvic incidence, sacral slope, pelvic tilt, and lumbar lordosis are found to be significantly greater in subjects with developmental spondylolisthesis, while thoracic kyphosis is significantly lower when compared to a reference population. Furthermore, the differences between the two populations increase in a direct linear fashion as the severity of the spondylolisthesis increases, suggesting that pelvic anatomy has a direct influence on the development of a spondylolisthesis. Studies also indicate that pelvic incidence is unaffected by surgical reduction and instrumentation. Pelvic tilt, sacral slope, and thoracic kyphosis are slightly affected, while grade, L5 incidence angle, lumbosacral angle, and shape of the lumbar spine are significantly improved after surgery. A postoperative improvement in L5 incidence angle and lumbosacral angle appears correlated with a better outcome while subjects with a poor outcome have a higher preoperative grade. CONCLUSIONS: Spino-pelvic balance in the sagittal plane can be considered as an open linear chain linking the head to the pelvis where the shape and orientation of each successive anatomic segment are closely related and influence the adjacent segment. Pelvic morphology and spino-pelvic balance are abnormal in developmental spondylolisthesis. These abnormalities should be quantified on lateral standing radiographs of the spine and pelvis and have important implications for the evaluation and treatment of this pathologic condition.

Humans↗

PubMed2005

The indications for interbody fusion cages in the treatment of spondylolisthesis: analysis of 120 cases.

STUDY DESIGN: This study retrospectively examines outcomes of unilateral transforaminal lumbar interbody fusion (TLIF) with posterior fixation using anterior carbon fiber cages and 360 degrees fusion in spondylolisthesis. OBJECTIVES: The goals were to examine the outcomes and perioperative complications of using anterior column support in the treatment of various types of spondylolisthesis. SUMMARY OF BACKGROUND DATA: In 2000, Brantigan et al reported the Brantigan interbody fusion cage used as a posterior lumbar interbody fusion in the US IDE clinical trial. This is the largest series to date of TLIF cages specifically used in the treatment of spondylolisthesis. METHODS: A comprehensive long-term follow-up study was conducted to evaluate the fusion success and morbidity following implantation with an anterior column support and posterior pedicle screw fixation. The 120 patients with spondylolisthesis were comprised by 11 cases, dysplastic; 58 cases, degenerative; and 51 cases, isthmic-acquired spondylolisthesis. Anterior column support was either a rectangular carbon fiber/PEEK device or a cylindrical carbon fiber/PEEK device. Twenty-eight cases (23%) were revisions. RESULTS: There were no pseudarthrosis, instrumentation failures, or significant subsidence at the TLIF level. The disc space height and foraminal height were restored as part of the surgical procedure. Disc height, as measured from the posterior edge of the superior vertebral body, increased from a mean of 5.6 mm before surgery to a mean of 9.3 mm after surgery. Although reduction of the slip was not the primary goal during the surgical procedure for the 120 cases with spondylolisthesis (isthmic-acquired = 51, degenerative = 58, and dysplastic = 11), the 23% slip reduction achieved at surgery was maintained at follow-up. Mean operative time was 143 +/- 33 minutes (range, 70-255 minutes) for all cases. Mean blood loss was 724 +/- 431 mL (range, 300-2,500 mL). There were seven incidental durotomies and three infections. One patient with Grade I degenerative spondylolisthesis required revision of the carbon fiber cage for posterior migration secondary to a traumatic event 3 months after surgery. Fusion success was 98% using the criteriaof Lenke for the posterior fusion and Brantigan and Steffee for the TLIF graft incorporation. CONCLUSIONS: Interbody cages in spondylolisthesis are useful to increase neuroforaminal height, to facilitate reduction, and to improve the chances of achieving a successful 360 degrees fusion.

Adolescent↗

PubMed2007

Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study.

STUDY DESIGN: A cross-sectional epidemiological survey of 4151 participants of the Copenhagen Osteoarthritis Study. OBJECTIVE: To identify prevalences and individual risk factors for degenerative lumbar spondylolisthesis. SUMMARY OF BACKGROUND DATA: The Copenhagen Osteoarthritis Study has registered health parameters since 1976. In 1993, standardized, lateral radiographs of the lumbar spine were recorded. There were 1533 men and 2618 women. METHODS: Statistical correlations were made between degenerative spondylolisthesis, and physical, occupational, and general epidemiological data. RESULTS: A total of 254 cases of lumbar slip were found (males 2.7%, females 8.4%). In females, no significant relationship between age at menopause or childbirths and the presence of degenerative spondylolisthesis were found. In women, relationships between body mass index (BMI) in 1976 and L4 olisthesis (P = 0.001), and between BMI in 1993 and both L4 and L5 olisthesis were found (L4: P = 0.003; L5: P = 0.006). Lumbar lordosis was associated with degenerative spondylolisthesis in women. Occupational exposures to daily lifting or smoking were not associated with degenerative spondylolisthesis. Degenerative spondylolisthesis was associated with increased age in both sexes (L4: P < 0.001; L5: P < 0.001). CONCLUSIONS: BMI longitudinally and at index evaluations, age, and angle of lordosis were significantly associated with degenerative spondylolisthesis in women. In men, no individual risk factors for degenerative spondylolisthesis were found, save increased age.

Adult↗

PubMed2003

[Traumatic spondylolisthesis of the axis].

PURPOSE OF THE STUDY: The study presents a group of patients with traumatic spondylolisthesis of the axis. Views on the treatment of different types of spondylolisthesis vary. The aim of this study was to carry out a retrospective evaluation of the group of patients with this traumatic condition. MATERIAL: In the period from 1995 to 2002, 26 patients with traumatic spondylolisthesis of the axis were treated. They accounted for 5% of all patients admitted to our department for cervical spine injuries. Three types of traumatic spondylolisthesis were distinguished according to the Effendi classification. Type I was diagnosed in seven, type II in 18 patients and type III in one patients. METHODS: Type I traumatic spondylolisthesis was, as a rule, treated conservatively. A halo vest was used in four and a Philadelphia collar in three patients. Patients diagnosed with type II spondylolisthesis were treated surgically from the anterior approach (16 patients) or with a halo vest (two patients). The only patient with a type III fracture was operated on from the anterior approach. RESULTS: Osseous healing was achieved in all patients. No pseudoarthrosis developed and no repeat surgery for infection or osteosynthesis failure was needed. No deterioration of neurological findings was recorded. The range of motion in the cervical spine after healing was not affected. DISCUSSION: Views on the classification and therapy of traumatic spondylolisthesis of the axis are diverse. The greatest diversity is associated with making a decision on whether the injury is unstable and requires surgical treatment or not. Further arguments are related to the use of the most suitable approach. Treatment from the anterior approach is prevailing. Type III fractures are rare and must always be treated surgically. CONCLUSIONS: Methods for treatment of traumatic spondylolisthesis of the axis are currently a topic of dispute. The decisive factor for therapy is whether the injury is stable or unstable. When instability is present, anterior C2-3 spondylodesis completed with plate osteosynthesis is the method of choice. Stable injuries are treated by the application of a halo vest or Philadelphia collar.

Adolescent↗

PubMed1982

Computed tomography in spondylolisthesis.

Fourth generation computed tomography (CT) diagnostic studies were used to investigate or localize, neurologic changes and to clarify the anatomy of slippage in a consecutive series of 31 patients who had spondylolisthesis. Eighteen patients had operative procedures, i.e, either spinal fusions, decompressions, or both, after the CT examinations, and the average follow-up was 25 months. Ten postoperative CT studies were performed to document the correction of the original pathology. Fifteen patients had objective neurologic deficits referable to the spondylolisthesis, of whom CT demonstrated the specific sites of neural encroachment in 13. Preoperative myelography was of limited use; complete block of contrast material occurred, and the etiology of nerve root compression was not visualized. In isthmic spondylolisthesis, CT showed a fibrocartilaginous mass at the pars interarticularis, compressing the adjacent nerve root, as described by Gill et al. In degenerative spondylolisthesis, severe lateral recess stenosis occurred. CT provided diagnostic evidence of a tethered cord in dysplastic spondylolisthesis, if displaced bony fragments in the canal in traumatic spondylolisthesis, and spinal infiltration of neoplasms in the pathologic type. CT is important preoperatively in cases of severe spondylolisthesis and can be used to determine which warrant decompression in addition to fusion. These results also support the concept that neurologic findings associated with spondylolisthesis can be due to a multitude of anatomic abnormalities and should not be simply attributed to a herniated nucleus pulposis at the slip.

Adolescent↗

PubMed1993

Decompression for degenerative spondylolisthesis and spinal stenosis at L4-5. The effects on facet joint morphology.

Anatomic variations exist in the facet joint orientation, shape, and size at L4-5. This morphology is further modified by degenerative changes in spinal stenosis and degenerative spondylolisthesis. This study explored the morphologic alteration of "pedicle-to-pedicle" decompression on the facet joints in normal patients, spinal stenosis patients, and degenerative spondylolisthesis patients. Using computerized digitization, computed tomographic scan images of the facet joint at L4-5 and the medial border of the pedicle at L5 were superimposed. The facet joint orientation, coronal dimension, percentage, and absolute reduction in coronal dimension after pedicle-to-pedicle decompression, and residual coronal dimension after decompression at L4-5 were measured for the three groups. There is a significantly reduced coronal dimension of the facet joint in degenerative spondylolisthesis patients compared with spinal stenosis and normal patients (P < 0.01). The average reduction of the facet joint coronal dimension is 34% (SD 30%) in degenerative spondylolisthesis, and 36% (SD 25%) in spinal stenosis. The smaller preoperative coronal dimension in degenerative spondylolisthesis leads to a significantly reduced residual coronal dimension in degenerative spondylolisthesis compared with normal patients (5.9 mm [SD 4.3 mm] vs. 9.3 mm [SD 3.5 mm]), respectively. Wide variations in facet joint reduction and residual facet joint coronal dimension exist. The significantly reduced coronal dimension after decompression in degenerative spondylolisthesis may be correlated to a trend to further anterior displacement if it is treated with decompression alone. Case-specific assessment of residual facet joint morphology after decompression in both spinal stenosis and degenerative spondylolisthesis patients should be integrated into decisions about fusion for stability at the L4-5 level.

Aged↗

PubMed2004

Degenerative spondylolisthesis of the cervical spine--symptoms and surgical strategies depending on disease progress.

BACKGROUND: Degenerative spondylolisthesis of the cervical spine is rare. Patients show signs of progredient myelopathy, radiculopathy and pain. Treatment strategies include ventral, dorsal and combined fusion techniques with or without repositioning and decompression. METHODS: In this study, we present 16 patients with degenerative cervical spondylolisthesis. The leading symptom was severe myelopathy in 8 patients, radiculomyelopathy in 5 patients and neck pain in 3 patients. However, neck pain was the initial symptom in all the patients and decreased when neurological symptoms became more evident. Radiographic examinations included plain radiography, MRI, CT, myelography and lateral tomography. RESULTS: Spondylolisthesis was located five times at level C3/4, C4/5 and C5/6. In three cases spondylolisthesis was located at level C7/T1. There were two patients with spondylolisthesis on two levels. Instability could be demonstrated by flexion/extension radiography in five cases. Patients were divided into three groups according to a newly introduced classification system. The surgical approach corresponded to this classification. In ten patients the spondylolisthesis could be corrected by extension and positioning, so discectomy and fusion on one or two levels with cage, plate and screws was sufficient. In five cases a corpectomy was necessary due to severe spondylosis. In one case a combined approach with dorsal decompression and release followed by ventral fusion was applied due to additional dorsal spinal cord compression. The follow-up period was 6-52 months. After surgery, none of the patients showed any signs of neurological deterioration. In all cases, a stable fusion was achieved with no signs of instability on flexion/extension radiographs. Neurological improvement was seen in 6 of 8 patients with myelopathy and 4 of 5 patients with radiculomyelopathy. The others showed stable disease. Pain relief was seen in all patients who complained of pain preoperatively. CONCLUSION: The aims of treatment for cervical spondylolisthesis are spinal cord decompression (ventral, dorsal or both), correction and fusion. The used procedure should depend on the severity of the cervical deformity, degree and side of the spinal cord compression, and the possibility of correction by extension and positioning.

Aged↗

PubMed2006

A proposal for a surgical classification of pediatric lumbosacral spondylolisthesis based on current literature.

The classification presented in this paper is the first specifically designed to guide surgical treatment of L5-S1 spondylolisthesis in children and adolescents. It also presents objective criteria to differentiate between low- and high-dysplastic spondylolisthesis and incorporates recent knowledge in the study of sagittal spinopelvic balance. The proposed classification is based on the following: (1) the degree of slip, (2) the degree of dysplasia, and (3) the sagittal spinopelvic balance. To classify a patient, the degree of slip is quantified first to determine if it is low-grade, high-grade, or a spondyloptosis. Then, the degree of dysplasia is evaluated based on seven criteria, in order to separate patients with low- and high-dysplastic spondylolisthesis. Finally, the sagittal spinopelvic balance is assessed from the measurement of the pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT). For low-grade spondylolisthesis, it is classified as low PI/low SS (nutcracker type) or high PI/high SS (shear type). For high-grade spondylolisthesis, it is classified as high SS/low PT (balanced pelvis) or low SS/high PT (retroverted pelvis). Such a comprehensive classification could allow to better evaluate and compare available surgical techniques, and to optimize the treatment of L5-S1 spondylolisthesis. Because the classification was designed so that groups are organized in an ascending order of severity, it becomes easier and more intuitive to develop an associated surgical algorithm because the complexity of the surgery should increase as the severity of the spondylolisthesis increases. A tentative treatment algorithm is proposed but it is not definitive because further studies are required to define the most appropriate treatment for each group.

Adolescent↗

PubMedDate not supplied

Minimally invasive anterior lumbar interbody fusion followed by percutaneous pedicle screw fixation for isthmic spondylolisthesis.

BACKGROUND CONTEXT: Most surgeons have thought that posterior decompression is necessary to treat isthmic spondylolisthesis with leg pain. However, the surgical procedure not only requires wide muscle dissection but can also lead to spinal instability. The authors' treatment concept for isthmic spondylolisthesis is one-stage anterior reduction and posterior stabilization with minimally invasive surgical procedure without touching the spinal thecal sac and nerve. PURPOSE: To investigate a new surgical concept of minimally invasive anterior-posterior fusion without posterior decompression for the treatment of isthmic spondylolisthesis with leg pain. STUDY DESIGN: This is a retrospective study of 73 patients with isthmic spondylolisthesis who underwent minimally invasive anterior lumbar interbody fusion (mini-ALIF) followed by percutaneous pedicle screw fixation (PF) between October 2000 and February 2002. PATIENT SAMPLE: A total of 73 patients with low-grade isthmic spondylolisthesis (46 with Grade 1 and 27 with Grade 2) who underwent mini-ALIF followed by percutaneous PF were retrospectively analyzed. There were 20 men and 53 women, with a mean age of 50.6 (range, 19 to 77) years. All patients had low back pain and referred or radicular leg pain or neurogenic intermittent claudication in walking or standing. Average duration of symptoms was 26 (range, 3 to 120) months. OUTCOME MEASURES: The clinical outcome was graded according to the modified Macnab criteria. METHODS: The authors retrospectively reviewed clinical and radiological data of 73 patients who had isthmic spondylolisthesis. All patients underwent mini-ALIF and percutaneous PF on the same day between October 2000 and February 2002. The mean follow-up period was 16 months (range, 12 to 26). RESULTS: The mean operating time, blood loss and hospital stay were 210 minutes, 135 ml and 4.1 days, respectively. No blood transfusion was necessary. Clinical outcome was excellent in 26 patients (35.6%), good in 43 (58.9%), fair in 3 (4.1%) and poor in 1 (1.4%). The fusion rate was 97.3% (71 of 73). There were 6 cases (8.2%) of mini-ALIF complications and 6 (8.2%) of percutaneous PF complications. There were no postoperative neurologic deficits. CONCLUSIONS: Mini-ALIF followed by percutaneous PF is an efficacious alternative for low-grade isthmic spondylolisthesis, and posterior decompression is not necessary to relieve leg symptoms. This minimally invasive combined procedure offers many advantages, such as preservation of posterior arch, no nerve retraction, less blood loss, excellent cosmetic results, high fusion rate and early discharge.

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