Indentation or compression of the cord is common with larger disks and is seen best on T2-weighted or gradient-echo sagittal images. When either herniated disks or osteophytes impinge onthe spinal cord, cord injury can result, which points out the importance of prompt, accurate diagnosisand definitive therapy. As with any contusion, cord edema and swelling develop that may be seen asfocal high-signal intensity on T2-weighted scans. There is also disruption of the blood-cord barrier,so enhancement may be observed with Gadolinium.
A lateral cervical spine radiograph shows grade I anterolisthesis of C on C arrow with fractures of the C pars interarticulares arrowheads American Journal of Neuroradiology
Meaning of Listhesis medical term
The objective of this study was to evaluate which fusion technique provides the best clinical and radiological outcome for adult low-grade lumbar isthmic spondylolisthesis, and to assess the overall clinical and radiological outcome of each fusion technique. A systematic review was performed. Medline, Embase, Current Contents, and Cochrane databases as well as reference lists of selected articles were searched. Randomised controlled trials (RCTs) were used to evaluate the best treatment; controlled studies and non-controlled studies were used to determine the outcomes after surgery. Two independent reviewers evaluated the studies with the methodological checklists of van Tulder and Jadad for the randomised studies and of Cowley for the non-randomised studies. The search resulted in 684 references and eventually 29 studies met the inclusion criteria, of which eight were RCTs, four were prospective, and 17 were retrospective case series. Ten of the case series did not clearly identify consecutive patient selection. All the eight RCTs evaluated the effect of different techniques of posterolateral fusion (PLF). Evidence was found that the PLF was superior to non-operative treatment (exercise). Circumferential fusion was compared to PLF, but no difference could be found. PLF with or without instrumentation was evaluated in three studies, but no benefits from additional instrumentation were found. Other comparisons within PLF showed no effect of decompression, alternative instrumentation, or bone graft substitute. The 21 case series included 24 patient groups. PLF was used in 15 groups, good or excellent clinical outcome varied from 60 to 98% and fusion rate varied from 81 to 100%. Anterior interbody fusion was used in five groups, good or excellent clinical outcome varied from 85 to 94% and fusion rate varied from 47 to 90%. Posterior interbody fusion was used in two groups, good or excellent clinical outcome was 45% and fusion rate was 80 and 95%, respectively. Reduction, loss of reduction, and lordotic angles before and after the treatment was reported in only four studies. Average reduction achieved was 12.3%, average loss of reduction at follow-up was 5.9%. Preoperative lordotic angles were too heterogeneous to pool the results. Adjacent segment degeneration was not reported in any of the publications. A wide variety of complications were reported in 18 studies and included neurological complications, instrument failure, and infections. Fusion for low-grade isthmic spondylolisthesis has better outcomes than non-operative treatment. The current study could not identify the best surgical technique (PLF, PLIF, ALIF, instrumentation) to perform the fusion. However, instrumentation and/or decompression may play a beneficial role in the modern practice of reduction and fusion for low-grade isthmic spondylolisthesis, but there are no studies yet available to confirm this. The outcomes of fusion are generally good, but reports vary widely.
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With the pars defect divides the vertebrainto an anterior part (vertebral body,pedicles, transverse processes, andsuperior articular facet) and aposterior part (inferior facet, laminae, and spinous process). The anterior part slips forward, leavingthe posterior part behind. As a result, the spinal canal elongates in its anteroposterior dimension, sothat spinal canal stenosis is uncommon with isthmic spondylolisthesis. Grade I spondylolisthesis isoften asymptomatic, but with progressive anterior subluxation, the intervertebral disk and theposterior-superior aspect of the vertebral body below encroach on the superior portion of the neuralforamen. The foramen is also elongated in a horizontal direction and may have a bilobedconfiguration. Exuberant fibrocartilage at the pars pseudarthrosis can further compromise the neuralforamen and cause nerve root compression.