Spondylolysis with or without spondylolisthesis is an often well-tolerated situation. However, growing or adult patients may experience severe back pain, referred pain or even neurological compromise that justifies surgical treatment. During growth, exceptionally in adult life, true instability with increase of the spondylolisthesis may also require stabilisation, in situ or after reduction of the deformity. Posterior, anterior and combined approaches intended to obtain correction and fusion have been described, the choice between available options remains difficult. The recent literature does not necessarily support procedures that seem more logical but are more invasive than others. While the importance of maintaining or restoring an adequate sagittal profile of the lumbar spine is universally well-accepted, the importance of slip correction is considered less important. This chapter intends to help the surgeon dealing with different situations encountered in spondylolysis and spondylolisthesis patients by first exposing the different techniques currently in use with their respective advantages and disadvantages and by considering the proper matching of the most logical procedure theoretically required by the anatomical situation and the functional expectations of the particular patient.
In patients with degenerative spondylolisthesis (10a,11a), the underlying abnormality is intersegmental instability caused by facet arthropathy. These patients will not have horizontal neural foramina, and the associated facet arthropathy, not a feature of isthmic spondylolisthesis, is readily apparent on axial scans.
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The symptoms of spondylosis are very . This is because the changes to the vertebrae and discs often impinge nerves in much the same way a bulging disc does. For instance, you will have pain that extends into your arms when the problem is in the neck or into the legs when it is in the lumbar region.
Spondylolysis and Spondylolisthesis Introduction
Type I. Dysplastic: This type results from congenital abnormalities of the upper sacral facets or inferior facets of the fifth lumbar vertebra that allow slipping of L5 on S1. There is no pars interarticularis defect in this type. The sacrum is not strong enough to withstand the weight and stress. Thus, the pars and inferior facets of L5 are deformed. If the pars elongates, it is impossible to differentiate it by x-ray from the isthmic (type II b) Spondylolisthesis. If the pars separates, it becomes impossible to differentiate it by x-ray from the isthmic lytic (type II a) Spondylolisthesis. This type is also associated with sacral and neural arch deficiencies. It has a familial tendency.
Spondylolysis & Spondylolisthesis Treatment Back Brace
Although this subtype has a strong hereditary tendency, it makes up only half of the dysplastic group. The elongated pars (subtype b) is believed to result from micro fractures that heal with an elongated pars rather than from a lytic lesion. Acute pars fractures (subtype c) always result from significant trauma; these are rare and most frequently occur with Spondylolysis rather than with Spondylolisthesis.
Spondylosis is a spinal stress fracture that usually occurs ..
In Spondylolysis, symptoms are often absent. Defects are then discovered only incidentally on x-ray made for other purposes. In Spondylolisthesis, injury may aggravate (permanently worsen) any symptoms, but rarely does a single injury cause symptoms in a person who previously had none. Symptoms generally begin insidiously during the second or third decade as an intermittent dull ache in the lower back, present with increasing frequency during walking and standing. Later, pain may develop in the buttocks and thighs, and still later unilateral sciatica may develop.
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There may be no objective signs in Spondylolysis, or in first or second degree Spondylolisthesis. The finding of Spondylolysis on x-ray in an adult is likely to be incidental, and not the cause of back pain if that pain did not commence in childhood or adolescence. Tightened hamstrings are present in the majority of those who are symptomatic. Tenderness and spasms of the paravertebral muscles may be present at the level of the vertebral defect and surrounding segments. Pain may be induced and increased by certain movements.