Lecture spondylolysis 2021

A lecture on spondylolysis fracture of the pars interarticularis of the spine.

1. Spondylolysis Spine Conference March 23 rd , 2021

2. Spondylo-lysis Spondylo-listhesis Spondylo -sis Isthmus Pars Interarticularis

3. lysis

4. PARS INTERARTICULARIS

5. Isthmus of Kho Phi Phi

6. Spondylolysis 16 year old national level club soccer player club team with LBP

7. How do you treat this patient?

8. 10 months later…..

9. 50% incidence among Inuit

10. Associated conditions 3 times greater incidence

11. Pelvic incidence Mean adult 57 deg >68.5 correlates to slip

12. Radiographic Analysis of the Sagittal Alignment and Balance of the Spine in Asymptomatic Subjects Raphaël Vialle , MD 1 ; Nicolas Levassor , MD 1 ; Ludovic Rillardon , MD 1 ; Alexandre Templier , MD 2 ; Wafa Skalli , MD 2 ; Pierre Guigui , MD 1   1  Department of Orthopaedic Surgery, Hôpital Beaujon , 100 Boulevard de Général Leclerc, F-92110 Clichy, France. E-mail address for R. Vialle : [email protected] 2  Department of Biomechanics, ENSAM-PARIS, 151 Boulevard de L'Hôpital , F-75013 Paris, France View Disclosures and Other Information The Journal of Bone & Joint Surgery.   2005; 87:260-267  doi:10.2106/JBJS.D.02043

13. Reciprocal measurements T9S1 S1 L5 L4 L3 L2 L1 T12 T11 T10 T9 S1 0 (0 to 0) L5 -23.3 -8 (-24 to -22.5) (-8.5 to -7.5) L4 -40 -24.6 -2.6 (-40.7 to -39) (-25 to -24) (-3 to -2.2) L3 -50.2 -34.9 -13 -0.6 (-51.2 to -49.3) (-35.8 to -34) (-13.6 to -12.4) (-0.9 to -0.3) L2 -57 -41.5 -19.50 -7.2 1.2 (-58 to -55.7) (-42.6 to -40) (-20.5 to -19) (-7.7 to -6.6) (0.8 to 1.5) L1 -58.5 -43 -21 -8.8 -0.45 3.8 (-60 to -57) (-44.4 to -42) (-22.3 to -20.2) (-9.7 to -8) (-1 to 0) (3.5 to 4) T12 -57.2 -42 -20 -7.5 0.8 5.1 4.5 (-58.5 to -56) (-43 to -40) (-21 to -19) (-8.5 to -6.6) (0 to 1.6) (4.5 to 5.6) (4.1 to 4.8) T11 -54 -38.8 -17 -4.5 4 8.2 7.6 4.8 (-55.5 to -53) (-40 to -37) (-18 to -16) (-5.6 to -3.5) (3 to 5) (7.4 to 9) (7 to 8) (4.5 to 5) T10 -52 -36.5 -14.5 -2.2 6.20 10.50 10 7 3 (-52 to -54) (-38 to -35) (-16 to -13) (-31 to -1) (5 to 7) (10 to 11) (9 to 10.5) (6.5 to 7.5) (2.6 to 3.2) T9 -49 -33.7 -11.8 0.6 9 13.3 12.7 10 5.7 3.5 (-50 to -48) (-35 to -32) (-13 to -10) (-0.5 to 1.7) (8 to 10) (12.5 to 14) (12 to 13) (9 to 10.5) (5.3 to 6.2) (3 to 3.7)

14. First Degree relatives

15. 4% progress to spondylolisthesis

16. Imaging Xrays CT MRI Bone scan

17. Pedicle edema

18. Osteiod osteoma

19. A: Buck direct screw B: Scott wiring technique C: Kakiuchi screw with laminar hook

20. Pedicle screw with infralaminar hook

21. Direct interlaminar screw repair

22. 61 year old man with right sciatica for several months with 2 opinions for L5S1 posterior spinal fusion finds a friend on the golf course that did extremely well with decompression surgery SH avid golfer retired fireman very healthy married

23. 30 man R>L LBP, pain L hip numbness anterior thigh, SH: IT analyst PE: 5’8” 175 lb

24. Thanks!