What Causes the Grade of Spondylolisthesis to Worsen?
Overview of the diagnosis and treatment of degenerative spondylolisthesis by the San Diego Center for Spinal Disorders
Spondylolisthesis Treatment, Surgery & Symptoms
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.
In an anatomic and MR study of cadaveric spines, Yu and colleagues found three types of anulartears in degenerated disks. Concentric tears (Type I) are caused by rupture of the short transversefibers connecting the lamellae of the anulus, and were seen as crescentic or oval spaces filled withfluid or mucoid material. In radial tears (Type II)the longitudinal fibers are disrupted through alllayers of the anulus, from the surface of the anulusto the nucleus. Transverse tears (Type III) resultfrom rupture of Sharpey's fibers near theirattachments with the ring apophysis, and areimaged as irregular fluid-filled cavities at theperiphery of the anulus.
Learn about the types and symptoms of spondylolisthesis
One of the earliest signs of disk degeneration is loss of water content or desiccation, mostnoticeable in the nucleus pulposus. MR can detect early disk degeneration because, as the disks losewater, the MR signal decreases on gradient-echo and T2-weighted images. With more advanceddegeneration, the disk collapses and gas may form within the disk. Calcification is not uncommonin chronic degenerative disk disease.
Those who play sports, especially gymnasts and football players, are more likely to have spondylolisthesis. The condition most often affects people over 40 years of age. About 5% of Americans have this structural deficiency and don't know it. Just because it appears on an X-ray doesn't mean you'll have pain.
The most common symptom of spondylolisthesis is lower back pain
Spondylosis can take the form of marginal end plate osteophytes, enlarged uncinate processes,or facet arthrosis. Degenerative joint disease itself, along with associated inflammatory reaction, cancause pain, or the symptoms can be derived from the osteophytes compressing neural structures. Itis important to distinguish spondylosis from disk disease for therapeutic planning.
Spondylolisthesis is most often caused by spondylolysis. The cause of spondylolysis is not as clearly defined. Most believe it is due to a genetic weakness of the pars interarticularis. Both spondylolysis and spondylolisthesis can be present at birth or occur through injury. Repeated stress fractures caused by hyperextension of the back (as in gymnastics and football) and traumatic fractures are also causes. The most common cause in adults is degenerative arthritis.
Multilevel Degenerative Disc Disease - Spinal Disorders
Multilevel degenerative disc disease affects more than one vertebra
Spondylolysis and spondylolisthesis are the most common causes of structural back pain in children and adolescents.
Adult Spondylolisthesis in the Low Back - OrthoInfo - …
Causes of Spondylolisthesis
The two most common types are degenerative and spondylolytic
The most common is degeneration of the components of the vertebral column and spine – degenerative spondylolisthesis.
Spondylolysis and spondylolisthesis - Mayfield Clinic
Mild cases of spondylolysis and spondylolisthesis usually cause minimal pain. In fact, the conditions are often found by accident when a person has a pre-employment exam or an X-ray of the back for an unrelated reason.
Spondylolysis and Spondylolisthesis of the Lumbar …
In the evaluation of degenerative spine disease, multiple anatomic sites need to be imaged,including the intervertebral disk, spinal canal, spinal cord, nerve roots, neuroforamina, facet joints,and the soft tissues within and surrounding the spine. Many pulse sequences are available, andspecific protocols vary among different MR sites. There is general agreement that the spine needsto be imaged in at least two planes, and surface coils are used almost exclusively. In the cervical andthoracic regions a T2-weighted sequence is mandatory to assess damage to the spinal cord. Thinsections are required to visualize the neuroforamina, and pulse sequences must be tailored tocounteract CSF flow and physiologic motion. The imaging requirements for the lumbar spine are lessstrenuous because the anatomical parts are larger. Most protocols include a T1-weighted sequenceand some type of T2-weighted sequence to give a myelographic effect. Fast spin-echo (FSE)techniques allow enormous time savings, and if available, they have replaced conventional spin-echofor T2-weighted imaging of the spine. Three-dimensional gradient-echo (GRE) methods can achieveslice thicknesses less than one millimeter, an advantage for displaying cervical neuroforamina.
Degenerative disc disease weakens one or more of your vertebral discs
The unco-vertebral joints (uncinate processes) are unique to the cervical spine. Withdegeneration, osteophytes develop at these joints and project into the lateral spinal canal andforamina. Symptoms are caused by impingement of nerve roots as they exit the foramina.
Your discs normally act as a cushion between the vertebrae
Spondylolisthesis is the actual slipping forward of the vertebral body (the term "listhesis" means "to slip forward") (Fig. 3). It occurs when the pars interarticularis separates and allows the vertebral body to move forward out of position causing pinched nerves and pain. Spondylolisthesis usually occurs between the fourth and fifth lumber vertebra or at the last lumbar vertebra and the sacrum. This is where your spine curves into its most pronounced "S" shape and where the stress is heaviest.
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