HighGradeSpondylolisthesis.pptx

The term spondylolisthesis is defined as a translation of one vertebra over another in the anterior or posterior direction.

Considering that the spondylolisthesis is “ a slippage of a portion of the column over the adjacent part”, we must remember that the column slid also moved the entire trunk, and this may bring clinical consequences.
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1. High Grade Spondylolisthesis Dr Tejasvi Agarwal Consultant Spine Surgeon Get Well Spine

2. Introduction The term spondylolisthesis is defined as a translation of one vertebra over another in the anterior or posterior direction. Considering that the spondylolisthesis is “ a slippage of a portion of the column over the adjacent part”, we must remember that the column slid also moved the entire trunk, and this may bring clinical consequences.

3. Spondylolisthesis and spondylolysis are usually well tolerated by patients, B ut in some cases the severity of the symptoms and a condition unresponsive to conventional medical treatment have caused the indication for surgical treatment.

4. Epidemiology and aetiology The incidence of spondylolysis in the general population is about 6%, with a male: female ratio of 2:1 . The incidence of spondylolisthesis in children under 6years is 2.6%, while in adults it is 5.4% . The degenerative spondylolisthesis rarely affects individuals below the age of 40 years, and is four to five times more common in women than in men.

5. The dysplastic lesions of the pars interarticularis , fracture or of the elongament and of spina bifida conceal a broad distal spinal canal. Dysplasia in both facets (lower lumbar and upper sacral ) is a common finding in spondylolisthesis, especially in those with high grade .

6. Dysplasia can occur in either or both facets. The presence of spondylolysis/spondylolisthesis is rare in non-ambulatory patients , W hich attaches importance to the orthostatism role and of repeated micro-traumas in the development of spondylolysis.

7. Activities that increase lordosis and maintain the column in extension, such as Olympic gymnastics, diving, weight lifting, volleyball, football and, P athologies such as kyphosis, increase the incidence of fracture of the pars and of spondylolysis and spondylolisthesis.

8. Sagittal balance in spondylolisthesis The spondylolistheses are divided into high (slippage >50% ) and low (slippage <50%) grade . The classifications used for spondylolisthesis are not useful for surgical treatment indications and, as noted in the last decade. the sagittal balance is the key factor for surgical treatment.

9. One explanation for the aetiology of developmental spondylolisthesis , which takes into account the sagittal balance , is that, in the presence of spondylolysis and bone dysplasia , the mechanical stress applied to the lumbo sacral junction is increased because of the altered sacro pelvic morphology , which leads to an abnormal secondary spino - pelvic equilibrium .

10. Pelvic Incidence(PI) Defined as the angle between the line connecting the midpoint of upper plateau of S1 and the centre of femoral rotation and the line perpendicular to the upper plateau of S1

11. Sacral Slope and Pelvic tilt

12. Sagittal Balance and Plumb Line

13. Conclusion: The proposed classification emphasizes that subjects with L5-S1 spondylolisthesis are a heterogeneous group with various adaptations of their posture, A nd that clinicians need to keep this fact in mind for evaluation and treatment .

14. Thankyou