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At least 19 recordsLinked to original sources
PubMed1987

[L4/L5 spondylolisthesis following reduction and stabilization by anterior and posterolateral graft of L5/S1 spondylolisthesis with major displacement].

40 children and adolescents, recurrence of a spondylolisthesis after posterior or even postero-lateral fusion is a well known fact. Anterior fusion added to the posterior graft is said to prevent such and occurrence. We report a case of a L4/L5 listhesis which followed near complete reduction of a 70% L5/S1 slip fixed by a combined approach. We think this is due to the persisting lumbo-sacral postural abnormalities and that while reducing and fixing the spondylolisthesis one should restore physiological posture to prevent this recurrence at the same level or at a higher one.

Child↗
PubMed1994

L4-5 isthmic spondylolisthesis. A biomechanical analysis comparing stability in L4-5 and L5-S1 isthmic spondylolisthesis.

The authors have previously reported that the L4-5 isthmic spondylolisthesis lesion often progresses more than the L5-S1 lesion in adult patients. This biomechanical study compares the in vitro stability of the L4-5 isthmic spondylolisthesis lesion compared with the L5-S1 isthmic lesion. The authors also analyzed the role of the L5 iliolumbar ligament as a contributing factor to stability. Six fresh frozen human cadaveric specimens (L4 to the sacrum including the iliolumbar ligamentous complex) were tested by applying 10 Nm flexion-extension moments. Sagittal plane motion was measured with the specimens intact and after sequential transection of the pars interarticulares at L4 and L5 and finally with the iliolumbar ligaments cut at L5-S1. L4-5 and L5-S1 both showed significant increases in rotation with the pars defect compared with normal (L4-5 = +2.0, L5-S1 = +3.2 degrees). Decreased translation of L5-S1 occurred with pars defect at this level. There were no significant differences at the L5-S1 level after sectioning of the iliolumbar ligament. Calculating the percentage difference from normal, L4-5 with a pars defect exhibited significantly greater relative motion compared with L5-S1 with the same defect; 12% more rotation, 33% more shear, and 43% more axial translation. The iliolumbar ligament did not appear to contribute to these differences because there was no significant change in the L5-S1 kinematics after its transection. These results support the hypothesis that L4-5 pars defects are more unstable than L5-S1 lesions. The iliolumbar ligament could not be implicated as the major contributing factor in these differences.

Biomechanical Phenomena↗
PubMed1994

Distinction between degenerative and isthmic spondylolisthesis on sagittal MR images: importance of increased anteroposterior diameter of the spinal canal ("wide canal sign").

OBJECTIVE: The purpose of this study was to determine whether a visually apparent increase in the anteroposterior diameter of the spinal canal ("wide canal sign") can be used reliably to differentiate degenerative from isthmic spondylolisthesis on midline sagittal MR images. We hypothesized that the wide canal sign would be present only in isthmic spondylolisthesis, where the vertebral ring is disrupted by defects in the pars interarticularis. MATERIALS AND METHODS: The midline sagittal MR images of 100 control subjects without spondylolysis or spondylolisthesis were analyzed to establish the normal range of sagittal canal diameters at the various lumbar levels. Midline sagittal MR images of the lumbar spine were reviewed in 53 patients in whom either isthmic (n = 35) or degenerative (n = 18) spondylolisthesis was confirmed with conventional radiography and/or CT. For each spinal level, the sagittal canal ratio, defined as the maximum anteroposterior diameter of the canal at that level divided by the diameter of the canal at L1, was calculated. From our analysis of the control subjects, a normal sagittal canal ratio was determined to be less than 1.25. A sagittal canal ratio of 1.25 or greater at the level of a spondylolisthesis was considered to represent an abnormally increased sagittal canal diameter (wide canal sign), indicating the presence of bilateral pars interarticularis defects. Using this sign alone, two neuroradiologists who had no knowledge of the true diagnosis classified the type of spondylolisthesis in a randomized subgroup of 34 age-matched adults (all more than 40 years old and with grade I isthmic or degenerative spondylolisthesis). RESULTS: In the 100 subjects without spondylolisthesis and in the 18 patients with degenerative spondylolisthesis, the sagittal canal ratio did not exceed 1.25 (mean values, 0.93-0.99) at any level of the lumbar spine. Conversely, the sagittal canal ratio at the level of isthmic spondylolisthesis exceeded 1.25 (mean value, 1.56) in 34 of 35 patients. In patients more than 40 years old, in whom degenerative spondylolisthesis is prevalent and misdiagnosis of isthmic spondylolisthesis is potentially more likely, both neuroradiologists were 100% accurate in correctly assigning the type of spondylolisthesis when using the wide canal sign alone. CONCLUSION: The wide canal sign on midline sagittal MR images (corresponding to an sagittal canal ratio > or = 1.25) is a reliable predictor of the presence of defects of the pars interarticularis at the level of a spondylolisthesis. This sign could be useful for distinguishing degenerative from isthmic spondylolisthesis when degenerative sclerosis in the pars interarticularis mimics spondylolysis, when direct axial imaging of the pars interarticularis has not been done, or when imaging is technically inadequate.

Adult↗
PubMed2002

Correlation of pelvic incidence with low- and high-grade isthmic spondylolisthesis.

PURPOSE: The development of isthmic spondylolisthesis is influenced by forces across the lumbosacral region of the spine. Pelvic incidence is a radiographic parameter that has been shown to be an independent parameter that influences both sagittal spinal balance and pelvic orientation. Our hypothesis then is that there is a positive correlation between pelvic incidence and spondylolisthesis. STUDY DESIGN: A radiographic analysis of cases with spondylolisthesis. OBJECTIVES: To try to assess the correlation between pelvic incidence in both low-grade and high-grade spondylolisthesis in both a pediatric and an adult population. SUMMARY OF BACKGROUND DATA: The concept of pelvic incidence has been introduced into the literature. Its exact association with spondylolisthesis has not yet been clarified. METHODS: Forty patients with spondylolisthesis were identified and divided into two groups: low-grade (Meyerding I-II) and high-grade (Meyerding III and higher). Radiographic parameters measured included lumbar sagittal alignment (T12-S1), sacral inclination, slip angle, and pelvic incidence. The spondylolisthesis was classified according to the Meyerding-Newman classifications and the slip angle. Radiographic measurements were also done in two control groups; there were 20 pediatric and 20 adult controls (mean age 11.8 years and 60.0 years, respectively). Unpaired t test analysis and Pearson correlation analysis were then done. RESULTS: Mean pelvic incidence was 47.4 degrees in the pediatric control group, 57 degrees in the adult control group, 68.5 degrees in the low-grade isthmic spondylolisthesis group, and 79.0 degrees in the high-grade isthmic spondylolisthesis group. Pelvic incidence was found to be significantly higher in the high- and low-grade spondylolisthesis groups compared with both control groups (P = 0.0001). Pelvic incidence was significantly higher in the high-grade isthmic spondylolisthesis group than in the low-grade isthmic spondylolisthesis group (P = 0.007). A significant correlation existed between pelvic incidence and Meyerding-Newman scores (P = 0.03). CONCLUSIONS: Pelvic incidence was significantly higher in patients with low- and high-grade isthmic spondylolisthesis as compared with controls and had significant correlation with the Meyerding-Newman grades (P = 0.03).

Adolescent↗
PubMed2005

Evaluation and management of high-grade spondylolisthesis in adults.

STUDY DESIGN: A retrospective review was performed on 21 adult patients surgically treated with high-grade spondylolisthesis (Grade III, IV, or V). Additionally, the natural history, classification, and surgical alternatives for high-grade spondylolisthesis in the adult are discussed through literature review. OBJECTIVES: The purpose of this article is to review the clinical and radiographic outcomes of surgical treatment of high-grade spondylolisthesis in the adult from a single institution. The natural history and treatment options for these adults are described in this review. SUMMARY OF BACKGROUND DATA: High-grade spondylolisthesis is typically diagnosed and treated in the child or adolescent. Most patients with high-grade spondylolisthesis received surgical treatment during their adolescence. Some patients, however, remain minimally symptomatic for life without surgery. Little has been written on the natural history or treatment of adults with high grades of spondylolisthesis. Most of the published reports on the surgical treatment of high-grade spondylolisthesis pertain to skeletally immature patients and maybe include a few adults in their series. Nonetheless, the different techniques of surgical treatment for high-grade spondylolisthesis that have been described in these studies can help the spinal surgeon in treatment options for this rare but difficult spinal deformity. METHODS: A literature review of the published manuscripts on the treatment of high-grade spondylolisthesis was performed with particular attention to the natural history and surgical treatment involving adult patients. Adult patients (older than 21 years) with high-grade spondylolisthesis treated surgically were retrospectively reviewed. Patients' clinical charts and radiographs were reviewed before and after surgery. Determination of fusion success, clinical outcome, and complications were performed. RESULTS: Twenty-one consecutive adults with high-grade spondylolisthesis who underwent lumbar spinal surgery were review retrospectively between 1990 and 2004. There were 13 females and 8 males with an average age of 35 years (range, 21-68 years). The average follow-up was 6.6 years. There were 11 Grade III, 6 Grade IV, and 4 Grade V slips, including 4 acquired and 17 developmental spondylolistheses. There were no pseudarthroses or significant instrumentation failures. There was 1 case of a complete cauda equina syndrome on a patient with preoperative symptoms of an incomplete cauda equina syndrome. CONCLUSIONS: Adult patients with high-grade spondylolisthesis not responding to nonoperative treatment can be stabilized in situ with posterior instrumentation from L4 to S1. The use of adjunctive fixation with iliac screws and/or transvertebral screws is recommended for the adult patient, particularly in revision or unstable cases. Reduction of the slipped vertebrae remains controversial for all grades of spondylolisthesis and more so for the adult patient. Partial reduction of the slip angle, decreasing the lumbosacral kyphosis, should be considered if significant sagittal malalignment is present or to improve arthrodesis success. Anterior column support should be performed, particularly when reduction has been obtained. Anterior column support can be performed, anteriorly or posteriorly, either by using inter vertebral body structural strut support or with a transsacral fibular dowel to improve stability and success of arthrodesis.

Adult↗
PubMed1998

Pathoanatomic mechanisms of degenerative spondylolisthesis. A radiographic study.

STUDY DESIGN: A retrospective case-control study was performed using the radiographs taken at the first hospital visit in two groups; in one group, spondylolisthesis developed after the first hospital visit, and, in the other, spondylolisthesis had not developed over 10 years. OBJECTIVES: To determine possible radiographic differences between these two groups to clarify the pathoanatomic mechanisms of anterior slipping. SUMMARY OF BACKGROUND DATA: The etiology of degenerative spondylolisthesis, for example, underlying pathoanatomic mechanisms such as dysfunction of the disc or horizontalization of the lamina and the facets, has been difficult to resolve, because radiographs taken before the occurrence of the slip have not been available in previous investigations. METHODS: Sixty-nine patients with spondylolisthesis in whom degenerative spondylolisthesis developed after the first hospital visit and for whom radiographs taken before the slip were available were studied retrospectively. In 63 patients slipping did not develop over 10 years, with or without intervertebral instability; these patients were studied as a control group. The radiographs taken before and after the occurrence of the slip in the patients with spondylolisthesis were examined and compared with those without spondylolisthesis. Dysfunction of the disc, horizontalization of the lamina and the facets, and the sagittal alignment of the facet joints were assessed in each group. RESULTS: Patients in whom anterior slipping developed had signs indicating that horizontalization of the lamina and the facets had occurred before the slip. However, the patients in whom spondylolisthesis did not develop had no horizontalization of the lamina and the facets at the first hospital visit or during the follow-up period. There was no significant difference in dysfunction of the disc between the cases with and without spondylolisthesis. Sagittal alignment of the facet joints was seen more frequently in the patients in whom slipping occurred than in patients with no spondylolisthesis, but approximately 40% of the patients in whom slipping occurred did not demonstrate sagittal alignment. CONCLUSION: Horizontalization of the lamina and the facets is a pathoanatomic risk factor that can predispose for the development of degenerative spondylolisthesis. If dysfunction of the disc occurs in addition to these conditions, spondylolisthesis may develop.

Adult↗
PubMed2005

New concepts on the pathogenesis and classification of spondylolisthesis.

STUDY DESIGN: A review of the literature in the English language pertaining to the pathogenesis and classification of spondylolisthesis. OBJECTIVE: To review the morphology and biomechanics of the lumbosacral junction as it relates to spondylolisthesis. To present contemporary theories of the development and progression of spondylolisthesis and an etiology-based classification system. SUMMARY OF BACKGROUND DATA: The proper treatment of spondylolisthesis is dependent on recognizing the type of slip and its natural history. Although a number of clinical and radiographic features have been identified as risk factors, their role as primary causative factors or secondary adaptive changes is not clear. In particular, confusion persists over the classification of slips with "isthmic defects." The early identification of spondylolisthesis that will progress to a high grade without intervention remains elusive. METHODS: A review of English language literature regarding the pathogenesis and classification of spondylolisthesis. RESULTS.: Current literature suggests that spinopelvic parameters, in addition to the morphology and biomechanics of the lumbosacral junction, play a causative role in the development of spondylolisthesis. Progression of developmental slips may be due to growth deficiencies of the anterosuperior sacrum, analogous to Blount's disease at the knee. The Marchetti-Bartolozzi classification system emphasizes the distinction between developmental dysplastic slips and acquired laminar stress fractures, both of which may have isthmic defects. These two types of spondylolisthesis have significantly different natural histories, suggesting the need for different treatment strategies. The Marchetti-Bartolozzi system also allows for the classification of postsurgical, pathologic, and degenerative forms of spondylolisthesis. CONCLUSIONS: The morphology of the lumbosacral junction resists high shear and compressive forces. The loss of the posterior restraint through an incompetent bony hook may result in the forward displacement of one vertebra on the subjacent vertebra. The spinopelvic parameters, such as pelvic incidence, may be greater determinants of development and progression than previously appreciated. The Marchetti-Bartolozzi classification system is applicable to all forms of lumbar spondylolisthesis,and seems to be clinically relevant in terms of treatment decisions. Their system emphasizes the distinction between developmental spondylolisthesis with lysis and acquired spondylitic spondylolisthesis, which have been included together in previous classification systems and caused confusion over natural history and treatment. Developmental slips have a greater propensity toward progression, which may be secondary to growth deficiencies of the upper sacrum. Further study is required to confirm these observations.

Disease Progression↗
PubMed2000

Sagittal plane configuration of the sacrum in spondylolisthesis.

STUDY DESIGN: A radiographic study of the sagittal sacral deformity in spondylolisthesis. OBJECTIVES: To characterize and classify the pathoanatomy of sagittal sacral deformation in spondylolisthesis. SUMMARY OF BACKGROUND DATA: Spondylolisthesis has been extensively described and reviewed in the literature. Deformity of the entire sacrum in spondylolisthesis potentially could affect the natural history, treatment options, and outcome. The sagittal contour of the entire human sacrum has never been quantitatively studied in spondylolisthesis. METHODS: A literature search was performed and data was gathered retrospectively on patients with spondylolisthesis at the authors' institution. Cases of degenerative spondylolisthesis were excluded. Specifically those patients with L5-S1 spondylolisthesis were studied. The authors studied standing lateral radiographs and performed statistical analysis to understand morphologic relations. RESULTS: A broad range of global sacral kyphosis (37-188 degrees ) exists in spondylolisthesis. Increasing sacral kyphosis is significantly associated with increasing percent slip, sacral horizontal angle, Neuman's classification, lumbar lordosis, and lumbar index. A simple classification of the spectrum of sacral deformity in the sagittal plane is presented. CONCLUSION: The entire sacrum in spondylolisthesis can develop a significant kyphotic deformity in the sagittal plane, and this is associated with other abnormalities found in the lumbosacral spine. Sacral deformity is a significant factor in the assessment of the sagittal contour of the patient with L5-S1 spondylolisthesis.

Adolescent↗
PubMed2005

Postoperative instability after laminoplasty for cervical myelopathy with spondylolisthesis.

OBJECTIVE: 76 patients who underwent laminoplasty for cervical spondylotic myelopathy were investigated regarding the impact of preoperative and postoperative degenerative spondylolisthesis on their neurologic outcome. METHODS: Radiographs were obtained 1 year postoperatively to investigate range of motion (ROM), lordotic curvature, and postoperative spondylolisthesis. RESULTS: By 1 year after surgery, 85% of those spondylolistheses present preoperatively had either resolved or improved on neutral lateral radiographs. The cross-sectional area of the spinal cord at the site of spondylolisthesis was measured using preoperative computed tomography myelography. Clinical results were evaluated by the recovery rate using Japanese Orthopaedic Association score. Patients with posterior spondylolisthesis showed a significantly poorer postoperative recovery rate. Intervertebral ROM in patients with preoperative spondylolisthesis was reduced, whereas cervical alignment had not deteriorated after laminoplasty. The group with posterior spondylolisthesis showed a significant reduction in the cross-sectional area of the spinal cord at the site of spondylolisthesis. Postoperative spondylolisthesis appeared in 15 patients, 10 of whom had preoperative spondylolisthesis at an adjacent site. CONCLUSION: The cause of poorer surgical results of those patients with preoperative posterior spondylolisthesis appears to be related to a higher degree of spinal cord compression than with preoperative anterior spondylolisthesis.

Aged↗
PubMed1990

[Scoliosis, spondylolysis and lumbosacral spondylolisthesis. A study of their association apropos of 82 cases in children and adolescents].

The authors have reviewed the charts of 82 patients who presented the association of a scoliosis and a spondylolisthesis. They insist upon the necessity to treat each abnormality for itself. 26 patients have been simply followed in the clinic, they required no treatment because of the modicity of the scoliosis and the spondylolisthesis. 23 patients were treated with orthosis because of the scoliosis progression. In this group the spondylolisthesis was not a major concern and remained stable. 15 patients had to be operated on because their scoliosis was threatening. The existence of a spondylolisthesis must not be a deterrent to the arthrodesis, and the orthotic treatment must not be carried on if inadequate. The risks to observe, below the spine fusion a progression of the slippage are extremely low (no case in our series). Although we tried to obtain a fusion of the lysis with an isthmic arthrodesis in two cases, we do not think that it represents a prerequisite to a spine fusion above the level of the lysis. 13 patients had a lumbosacral fusion for a great slippage spondylolisthesis. In this group the scoliosis had no relationship with the spondylolisthesis in four patients. But, in nine patients the scoliosis appeared to be directly related to the spondylolisthesis. The "Arthrodesis-reduction" of the spondylolisthesis enabled us to correct, at least partially, the scoliosis. At last 3 patients had a great slippage spondylolisthesis, and a threatening scoliosis. For these rare cases we propose the lumbosacral fusion with reduction of the spondylolisthesis and then, a few months later, an arthrodesis of the scoliosis as we have carried out twice successfully.

Adolescent↗