spondylo listhesis

spondylo listhesis

1. Spondylolisthesis Dr sharan

2. Spondylolisthesis Definition: Anterior or posterior translational displacement of one vertebral body over another. Due to: 1. Trauma 2. Degenerative changes 3. Defects in the bony architecture congenital or pathological

3. Five part wiltse classification o f the etiology of spondylolisthesis Type I Dysplastic Spondylolisthesis : secondary to a congenital defect of either the superior sacral or inferior L5 facets or both with gradual slipping of the L5 vertebra

4. Type II Isthmic or spondylolytic : the lesion is in the isthmus or pars interarticularis , spondylolysis :If a defect in the pars interarticularis & no slipping. Spondylolisthesis :If one vertebra has slipped forward.

5. Type II A: Lytic or stress spondylolisthesis and is most likely caused by recurrent micro-fractures caused by hyperextension. It is also called a "stress fracture" of the pars interarticularis and is much more common in males

6. Type II B probably also occurs from micro-fractures in the pars. However, in contrast to Type II A, the pars interarticularii remain intact but stretched out as the fracture fill in with new bone

7. Type II C is very rare in occurrence and is caused by an acute fracture of the pars. Nuclear imaging may be needed to establish diagnosis

8. Type III D egenerative spondylolisthesis , and occurs as a result of the degeneration of the lumbar facet joints. The alteration in these joints can allow forward or backward vertebral displacement. Most often seen in older patients. There is no pars defect and the vertebral slippage is never greater than 30%

9. Type IV traumatic spondylolisthesis , is associated with acute fracture of a posterior element (pedicle, lamina or facets) other than the pars interarticularis

10. Type V, pathologic spondylolisthesis , occurs because of a structural weakness of the bone secondary to a disease process such as a tumor or other bone diseases

11. Isthmic lysis The isthmic defect happens as a result of compression caused by the lower articular process of the superior vertebra on the isthmic region in hyperlordosis The isthmus of L5 is more horizontal than upper levels

12. Lumbar hyperflexion L5 is caught between the L4 inferior and S1 articular surface Resulting stress force on pars interarticularis

13. Isthemic lysis is due to anterioposterior postural imbalance and secondary spondylolisthesis is readjacent mechanism to adapt to postural imbalance

14. Dysplastic forms Slippage occurs at an age when growth is not complete Affecting growth of involved vertebrae Vertebral elements exposed to excessive forces growing less than non stressed vertebrae

15. Traumatic Listhesis Traumatic listhesis is rare condition. Results from Acute fracture of the posterior element other then pars interarticularis It is fracture dislocation of the spine involving all three columns It is the shear forces which cause break in the posterior stabilizers and the force is transmitted at the level of Intervertebral disc resulting in anterior or posterior displacement of the vertebral body.

16. Degenrative Pathogenic Degenerative destruction of posterior joints Degenerative disc can nno longer maintain vertebral relationship Displacement occurs Inferior joints of cephalad vertebrae contract and expand due to instability of superior articular process of inferior vertebrae Compensatory hypertrophy

17. Diagnosis Step off sign at adjacent spinous process Tenderness on midline Neurological signs Contracture of quadriceps and ischiocrural muscles

18. Treatment Conservative management Immobilization with brace for 6 weeks Pain killers, anti inflammatory and injection may limit pain but does not heal fracture Rehabilitation Sports like swimming will reduce the load on disc

19. Surgical management Direct screw fixation Wire based or wire screw fixation Screwed hooks with compressive springe Hooks associated with pedicular screws Pedicular screws with bend rod Bicortical screw hooks with transverse connection Arthrodesis

20. Isolated decompression or discectomy may increase instability and salvage secondary fusion

21. Thank you