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- increased incidence of L5-S1 disc degeneration

Normally L5/S1 disc is in 20-30° lordosis

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Adult Isthmic Spondylolisthesis - Spine - Orthobullets

Bone scanning can be very useful in demonstrating acute fracture of the pars interarticularis in persons with isthmic-type spondylolisthesis. It is also used in degenerative-type slips to reveal any acute reaction, though it has low specificity in this application.

This adolescent girl had a high-grade spondylolisthesis of L5/S1.

The results on isthmic-type spondylolisthesis have been the most promising. Most investigators report a 75-95% rate of good-to-excellent outcome. Most patients undergoing surgery report an improvement in the quality of life and level of pain. Surprisingly, the outcome in most studies does not correlate with the degree of spondylolisthesis or the slip angle. Some long-term follow-up studies support conservative treatment of asymptomatic children and teenagers with spondylolisthesis (type I or II), regardless of the grade; however, most investigators advocate fusion when the slip is symptomatic, unresponsive to conservative measures, or high-grade.

Treatment Options for Isthmic Spondylolisthesis

Data from the Spine Outcomes Research Trial (SPORT) study were analyzed to determine if duration of symptoms affects outcomes after treatment of spinal stenosis or degenerative spondylolisthesis.[14] In spinal stenosis patients with symptoms for more than 12 months, outcomes were worse compared with spinal stenosis patients with symptoms for fewer than 12 months, who experienced significantly better surgical and nonsurgical treatment outcomes. On the same basis of symptom duration before treatment, no differences were noted in outcomes for degenerative spondylolisthesis patients.

Degenerative spondylolisthesis is observed more frequently as the population ages and occurs most frequently at the L4-L5 level. As many as 5.8% of men and 9.1% of women are believed to have this type of listhesis.

09/01/2018 · Isthmic spondylolisthesis, ..

The patient with degenerative spondylolisthesis is typically older and presents with back pain, radiculopathy, neurogenic claudication, or a combination of these symptoms. The slip is most common at L4-5 and less common at L3-4. The radicular symptoms often result from lateral recess stenosis from facet and ligamentous hypertrophy, disk herniation, or both. The L5 nerve root is affected most commonly and causes weakness of the extensor hallucis longus. Concomitant central stenosis and neurogenic claudication may or may not exist.

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.

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Treatment of Isthmic Spondylolisthesis

Before surgery is considered for adult patients presenting with degenerative spondylolisthesis, minimal neurologic signs, or mechanical back pain alone, conservative measures should be exhausted, and a thorough evaluation of social and psychological factors should be undertaken.

Explaining Spinal Disorders: Isthmic Spondylolisthesis

Pathologic spondylolisthesis results from generalized bone disease, which causes abnormal mineralization, remodeling, and attenuation of the posterior elements leading to the slip.

Normal Spinal Anatomy Dr Robert Pashman MD Los …

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 - PhysioWorks

In traumatic spondylolisthesis, any part (usually not the pars) of the neural arch can be fractured, leading to the unstable vertebral subluxation.

What Causes a Spondylolisthesis

Although technology continues to improve the performance of surgical treatment, the most challenging task is simply optimal patient selection. As stated previously, clear indications for fusion must be present in order to optimize outcome, and controversies still exist, especially in the treatment of degenerative spondylolisthesis, that must be resolved in a methodic and scientific manner. Prospective randomized studies with independent evaluators probably will produce the greatest improvement to the outcome of lumbar fusions.

Isthmic vs Degenerative Spondylolisthesis

The SPORT (Spine Patient Outcomes Research Trial) study analyzed the cost-effectiveness of surgery versus nonoperative care in patients with spinal stenosis, degenerative spondylolisthesis, and intervertebral disk herniation.[15] In this trial, surgical therapy overall improved health and provided better value over 4 years as compared with nonoperative care.

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