The Grades I-V of spondylolisthesis and spondyloptosis
Spiegel DA, Dormans JP. Spondylolysis and spondylolisthesis. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 671.6.
Spondylolisthesis in lumbar region. X-ray.
A condition called spondylolysis can lead to the slippage that happens with spondylolisthesis. Spondylolysis is a defect in the bony ring of the spinal column. It affects the pars interarticularis, mentioned earlier. This defect is most commonly thought to be a stress fracture that happens from repeated strains on the bony ring. Participants in gymnastics and football commonly suffer these strains. Spondylolysis can lead to the spine slippage when a fracture occurs on both sides of the bony ring. This slippage is called spondylolisthesis. The slippage is graded from I through IV, one being mild, IV often causing neurological symptoms. The back section of the bony ring separates from the main vertebral body, so the injured vertebra is no longer connected by bone to the one below it. In this situation, the facet joints can’t provide their normal support. The vertebra on top is then free to slip forward over the one below.
Pathologic spondylolisthesis: Caused by a defect in the bone, Pathologic spondylolisthesis is caused by abnormal bone, such as from a tumor.
Over time, as the result of a pars intraarticularis defect, the adjacent vertebrae may slip forward, resulting in a condition known as spondylolisthesis. Another form, called degenerative spondylolisthesis, is caused by the degenerative deterioration of the facet joints and discs. Symptoms of both may include localized low back pain and/or radiating leg pain in the case of spondylolisthesis with nerve compression.Many young athletes pushing themselves to excel in sports like football or gymnastics may experience minor sports-related aches such as muscle or back pain. When persistent back pain interferes with participation in a favorite sport, however, it may be an indication of the presence of spondylolysis. Left untreated, spondylolysis can develop into spondylolisthesis and sideline an athlete for more than just a sporting season. Normally, the bones of the spine (the vertebrae) stand neatly stacked on top of one another. Ligaments and joints support the spine. Spondylolisthesis alters the alignment of the spine. In this condition, one of the spine bones slips forward over the one below it. As the bone slips forward, the nearby tissues and nerves may become irritated and painful.For most patients with spondylolysis and spondylolisthesis, back pain and other symptoms will improve with conservative treatment. This always begins with a period of rest from sports and other strenuous activities.In some cases, the stress fracture weakens the bone so much that it is unable to maintain its proper position in the spine—and the vertebra starts to shift or slip out of place. This condition is called spondylolisthesis.Generally, surgical stabilization is recommended, which involves and the use of surgical instrumentation to facilitate in healing.
“In the population of young athletes with spondylolysis, only about 5% will progress to spondylolisthesis,” notes Dr. Green. “But there are other causes of spondylolisthesis, particularly in adults; the condition may result from spine surgery which destabilizes the area, a tumor, or severe , or it may be congenital in origin.” The primary concern with leaving spondylolysis untreated is that in some cases, the condition progresses to spondylolisthesis, a diagnosis which is made when the affected vertebra slips forward relative to the vertebra below. In its mild form, this condition can also be treated conservatively If slippage exceeds 50% of the width of the vertebra, the patient may experience significant pain and may be in danger of nerve injury.Treatment of children at risk for spondylolysis (and for spondylolisthesis that evolves from untreated spondylolysis) may benefit from ongoing research at HSS. Working together with scientists in the at HSS, Dr. Green and his colleagues are studying anatomic predisposition of the spine to spondylolysis in order to further understand the causes of the condition. Dr. Green is also working with , Chief of the Division of Teleradiology, on a clinical imaging study on patients with stress reactions in the lower lumbar spine. Spondylolisthesis may very rarely be congenital, which means it is present at birth. It can also occur in childhood as a result of injury. In older adults, degeneration of the disc and facet (spinal) joints can lead to spondylolisthesis.If left untreated, spondylolysis can weaken the vertebra so much that it is unable to maintain its proper position in the spine. This condition is called spondylolisthesis.