Adult Isthmic Spondylolisthesis

Jones, T Rupert; Rao, Raj D.

doi:10.5435/00124635-200910000-00003

Cited by 62 publications

(64 citation statements)

References 45 publications

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“…33.1). 1 Surgical intervention criteria, following failure to respond to 6 months of nonsurgical treatment, include progression of slippage of greater than 30%, subluxation greater than grade II, progressive neurologic symptoms, and physical deformity. The goals of surgical intervention via fusion of the affected levels are restoration of disk height; reduction of slip angle and, if possible, forward translation; improvement in sagittal alignment; and improvement of functional outcome.…”

Section: Treatmentmentioning

confidence: 99%

Adult Isthmic Spondylolisthesis

2013

Decision Making in Spinal Care

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Adult isthmic spondylolisthesis (AIS), a subluxation of a vertebral body (VB) over a subadjacent VB, occurs in 6% of the general population. 1 Although the etiology of AIS is unclear, a genetic basis for isthmic spondylolisthesis is supported by the observation that familial incidence is 25-30%. 2 Acute fatigue-induced spondylolytic lumbosacral stress fractures are also implicated in isthmic spondylolisthesis. Pelvic lordosis correlates with both incidence of AIS and degree of vertebral slip. Regardless of the mechanism, an established defect in the pars interarticularis, or isthmus, progresses to a frank slippage as anatomic and biomechanical forces compromise bone repair. Biomechanical complications arise from forward forces on the spinal axis, and paraspinal muscle strain occurs from prolonged compensation of misaligned sagittal balance. The incidence of slip progression in the asymptomatic adult patient is 5%, with the overall likelihood of progression decreasing with age. 1 Neurologic sequelae arise from changing spinal canal dimensions or compromise of the neural foramina. The most common location of a pars defect is at L5, which accounts for 90% of cases. This results in subluxation at the L5-S1 level. 2 The incidence of spondylolysis in adult high-level athletes (8%) is comparable to that in the general population. Conversely, athletes who participate in throwing sports, gymnastics, rowing, weight lifting, and swimming are found to have higher incidences of spondylolysis. 3 ClassificationThree types of AIS have been described. 2 Subtype A is the classic lytic-fatigue pars lesion. Subtype B is an elongated, but intact isthmus, representing a healed fracture. Subtype C is an acute fracture of the pars. Grading of spondylolisthesis on the lateral radiograph had been proposed by Myerding as follows: grade 1, 1-24% slip; grade II, 25-49% slip; grade III, 50-74% slip; grade IV, 75-99% slip;This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

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Section: Treatmentmentioning

confidence: 99%

Adult Isthmic Spondylolisthesis

2013

Decision Making in Spinal Care

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“…Isthmic Spondylolisthesis treatment depends upon the severity of its symptoms. Treatment of choice for mild Spondylolisthesis is physical therapy, non-steroidal anti-inflammatory drugs, and modification of patents deli activities, which makes patients, feel comfortable from pain and rest for 10-20 days [14]. After adults fail to respond up to 3-6 months of conservative management, operative management is required [15].…”

Section: Introduction Backgroundmentioning

confidence: 99%

“…Types of spondylolisthesis include: pathologic, isthmic, congenital, post-operative, traumatic, and degenerative [13] Deformity are associated with collision of nerve root from its original place, which results in neurological symptoms and degenerative changes [14]. Isthmic Spondylolisthesis treatment depends upon the severity of its symptoms.…”

Section: Introduction Backgroundmentioning

confidence: 99%

“…About 90% of all vertebral body slips due to the degenerative and isthmic types of spondylolisthesis [11]. Generally in population after the forth decades 20.7% are affected [12], lumbosacral junction at lumber 5 and sacrum 1 (L5-S1) are mostly affected.Types of spondylolisthesis include: pathologic, isthmic, congenital, post-operative, traumatic, and degenerative [13] Deformity are associated with collision of nerve root from its original place, which results in neurological symptoms and degenerative changes [14]. Isthmic Spondylolisthesis treatment depends upon the severity of its symptoms.…”

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confidence: 99%

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Comparison of Simple Lumbar Interbody Fusion with CircumferentialFusion for Treatment of Isthmic Spondylolisthesis

Akter¹,

Hasan²,

Sana³

et al. 2017

Orthop Muscular Syst

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Purpose: Spondylolisthesis is a common cause of surgery in patients with lower back pain. Although interbody fusion and circumferential fusion are a relatively common surgical method for the treatment of spondylolisthesis, we retrospectively compared surgical reduction or fusion in situ with simple lumbar interbody fusion (PLIF/TLIF) and circumferential fusion (PLF+TLIF/PLIF) for adult isthmic spondylolisthesis in terms of surgical invasiveness, clinical and radiographical outcomes, and complications.Methods: From January 2013 to June 2015, 84 adult patients with isthmic spondylolisthesis who underwent surgical treatment in our department were randomized to simple lumbar interbody fusion (PLIF/TLIF) group (group 1, n=45) and circumferential fusion (PLF+TLIF/PLIF) group (group 2, n=39), and followed up for average 28.6 months (range 24-54 months). All patients of both groups had low back pain as their predominant symptom, with varying degree of radicular pain and neurological symptoms. The data collected retrospectively for analysis were: duration of symptoms, levels of fusion, revision surgery, clinical and radiographic results after surgery, and complications. Results:All the 84 patients compared in two surgical approaches for IS were included in this retrospective studies. In our analysis, for the surgical management of isthmic spondylolisthesis, we indicated that both approaches lumbar interbody fusion (PLIF/TLIF) and circumferential fusion (PLF+TLIF/PLIF) have equal significant, greater fusion rates with successful clinical outcomes. Conclusion:Our clinical experience along with statistic findings indicates that in conclusion, there was no significant difference was found between simple interbody fusion (PLIF/TLIF) compared to circumferential fusion (PLF+TLIF/PLIF). Moreover, both techniques led to similar surgical outcomes and complication during follow-up. Thus, these results suggest that both procedures are equally effective for the treatment of isthmic spondylolisthesis. Keywords: Introduction BackgroundSpinal fusion technique was introduced 70 years ago for the treatment of degenerative disc disease and chronic lower back pain [1]. Hibbs and Albee were two spine surgeons in 1911, who performed first spinal stabilization surgery [2,3]. Forward displacement of a vertebral bone in sequence of normal alignment of vertebra is called Isthmic Spondylolisthesis-most commonly due to progressive vertebral body malalignment in the lumbar region of spine. Even in severe case of spondylolisthesis, the slipped vertebra is comfortably reduced by the modern surgical techniques [4][5][6][7].However, these operations have high risk of neurological complications from the implant and screws, even in correct procedure, there areneurological complications [8]. There are no significant neurological complication differences found between the reduction procedure and fusion situ [5,[8][9][10]. About 90% of all vertebral body slips due to the degenerative and isthmic types of spondylolisthesis [11]. Generally in populati...

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“…These severe neurologic injuries may be more common in patients with a high-grade spondylolisthesis and an elongated, but intact (subtype B), pars interarticularis [ 20 ].…”

Section: Neurologic Symptomsmentioning

confidence: 99%