spondiolisthesis is one of spine injury.

spondiolisthesis

1. Spondiolisthesis

2. SPONDYLOLISTHESIS Spondylolisthesis’ means forward translation of one segment of the spine upon another. The shift is nearly always between L4 and L5, or between L5 and thesacrum (11% occur at L4/5 and 82% occur at L5/S1). Normal discs, laminae and facets constitute a locking mechanism that prevents each vertebra from moving forwards on the one below. Forward shift (or slip) occurs only when this mechanism has failed.

3. Grading Grades of Spondylolisthesis: Grade I is a slip of up to 25%. Grade II is between 26%-50%. Grade III is between 51%-75%. Grade IV is between 76%-100%. Grade V, or spondyloptosis , occurs when the vertebra has completely fallen off the nextvertebra

4. Classification The Wiltse −Newman classification of Spondylolisthesis is most commonly used: 1. Congenital – familial 2. Isthmic – common among adolescents associated with backpains. 3. Degenerative – common among women above 50 years old 4. Traumatic – caused mostly by accidents 5. Pathologic – tumors, infection or cancer in origin 6. Iatrogenic - idiopathic

5. Pathology Type I dysplastic spondylolisthesis will progress in 32% of cases. They are more likely to become high-grade slips with significant chance of neurological injuryand more commonly require surgery. Anterior ver-tebral translation results in a sagittal deformity with compensatory pelvic rotation. This results in a verti-cal sacrum and loss of lumbar lordosis. With forwardslipping there is compression on the cauda equina and the exiting foraminal nerve roots (L5). The degree of slip is measured by the amount of overlap of vertebral bodies and is expressed as a percentage. High- gradeslips have more than 50% translation.

6. Type II pars isthmic stress fractures, healing can occur with immobilization especially with unilateral defects. When non-union occurs, the fracture becomes corticalized and filled with fibrous tissue. A ‘lytic’ defectis visible on X-ray. The loss of the posterior facet support results in increased disc loads with subsequent degeneration and a small risk of spondylolisthesis (4%). Type III is characterized by segmental ‘instability’ due to disc or facet incompetence with osteophytes and facet effusions. Lateral recess stenosis occurs due to facet osteophytes and ligamentum flavum hypertrophy which encroaches on the traversing nerve roots. Occasionally there is foraminal stenosis whichcompresses the exiting nerve root.

7. SYMPTOMS • lower back pain – which is usually worse when you're active or when you'retanding, and is often relieved by lying down • pain, numbness or a tingling feeling spreading from your lower back down yourlegs (sciatica) – this happens if the bone in the spine presses on a nerve • tight hamstring muscles • stiffness or tenderness in your back • curvature of the spine (kyphosis)

8. DIAGNOSTIC PROCEDURES X-rays CAT/CT scan MRI scan

9. MEDICAL MANAGEMENT • a short period of rest, avoiding activities such as bending, lifting, contact sports,and athletics • Non-steroidal anti-inflammatory painkillers, such as ibuprofen • physiotherapy – simple stretching and strengthening exercises may help increase the range of motion in your lower back and hamstrings • if you have pain, numbness and tingling in your legs, corticosteroid injections around the compressed nerve and into the center of your spine may be recommended

10. Operative treatment indicated if: the symptoms are disabling and interfere significantly with work and recreational activities (loss of activities of daily living) the slip is more than 50% and progressing neurological compression is significant.