Correction of the listhesis is associated with risk of neurologic injury, both transient and permanent. Some surgeons prefer to fuse the spine in place rather than to reduce the subluxation. In persons with higher-grade spondylolisthesis, use of interbody grafts is associated with a high rate of complications. However, the use of these devices adds to the stability of the spinal segment, helps with the reduction of the deformity, and helps achieve sagittal balance, thus ensuring better outcome.
Spondylolisthesis is generally defined as an anterior or posterior slipping or displacement of one vertebra on another. A unilateral or bilateral defect (lesion or fracture) of the pars interarticularis without displacement of the vertebra is known as Spondylolysis. The pars interarticularis is the posterior plate of bone that connects the superior and inferior articular facets of a vertebral body.
Tosteson.Degenerative Spondylolisthesis: MIS vs.
When spondylosis occurs, lumbar radiculopathy--with pain, tingling, numbness, and muscle weakness--may result. Often, the first signs of lumbar spondylosis are morning stiffness and pain. It's quite common for more than one vertebra to be affected by spondylosis. Since the lumbar spine carries the bulk of the body weight, degeneration of the vertebrae support may be most noticeable with repetitive movements such as bending or lifting.
49: Lumbar Spondylolysis and Spondylolisthesis
Identifying Lumbar Spondylosis
Diagnosis of lumbar spondylosis consists of a physical examination, neurological examination (to assess sensation and motor function), imaging studies (such as x-rays, CT scan, or MRI), and possibly discography. Once a diagnosis of lumbar spondylosis is confirmed, a treatment regimen is established. Conservative treatment consists of muscle relaxants, anti-inflammatory medication, and physical therapy. If conservative treatment is unsuccessful in relieving the symptoms, the patient is then referred to a spinal surgeon to determine if surgery is an option.
Lumbar Spondylolysis and Spondylolisthesis
The etiology of spondylolisthesis is multifactorial. A congenital predisposition exists in types 1 and 2, and posture, gravity, rotational forces, and high concentration of stress loading all play parts in the development of the slip.
Do I Have Lumbar Spondylolisthesis or Spondylolysis?
As the spine degenerates with age, arthritis and spondylolisthesis are fairly common problems. Fortunately this does not uniformly result in disabling pain. For those patients that do have pain, a proper course of non-operative treatment can be very successful. For those who have failed this, fusion can be very successful in the right patient.
Lumbar Spondylolisthesis & Spondylolysis Surgery
In degenerative spondylolisthesis, intersegmental instability is present as a result of degenerative disk disease and facet arthropathy. These processes are collectively known as spondylosis (ie, acquired age-related degeneration). The slip occurs from progressive spondylosis within this three-joint motion complex. This typically occurs at L4-5, and elderly females are most commonly affected. The L5 nerve root is usually compressed from lateral recess stenosis as a result of facet and/or ligamentous hypertrophy.