|
:::
 |
 Now：Home page > Spine Disease > Spondylolisthesis |
|
|
|
 |
|
Spondylolisthesis |
|
Spondylolisthesis is the forward displacement of one vertebra on another, usually the fifth lumbar on the sacrum, or the fourth lumbar on the fifth. It may be due to a developmental defect or a fatigue fracture in a certain area of the vertebra. This defect in the pars occurs in 5-8% of the population of unknown cause, but often related to an acquired condition or as a result of repetitive stress (weight lifters, gymnasts, football lineman). |
|
Describing Spondylolisthesis |
|
Spondylolisthesis can be described according to its degree of severity. One commonly used description grades spondylolisthesis, with grade 1 being least advanced, and grade 5 being most advanced. The spondylolisthesis is graded by measuring how much of a vertebral body has slipped forward over the body beneath it.
| Grade 1 |
25% of vertebral body has slipped forward |
| Grade 2 |
50% of vertebral body has slipped forward |
| Grade 3 |
75% of vertebral body has slipped forward |
| Grade 4 |
100% of vertebral body has slipped forward |
| Grade 5 |
Vertebral body completely fallen off (i.e.,spondyloptosis) |
|
|
Causes |
| |
Approximately 5-6% of males, and 2-3% of females have a spondylolisthesis. It becomes apparent more often in people who are involved with very physical activities such as weightlifting, gymnastics, or football. Males are more likely than females to develop symptoms from the disorder, primarily due to their engaging in more physical activities. Although some children under the age of five may be pre-disposed towards having a spondylolisthesis, or may indeed already have an undetected spondylolisthesis, it is rare that such young children are diagnosed with spondylolisthesis. Spondylolisthesis becomes more common among 7-10 year olds. The increased physical activities of adolescence and adulthood, along with the wear- and-tear of daily life, result in spondylolisthesis being most common among adolescents and adults. |
|
Types of Spondylolisthesis |
| |
Different types of spondylolisthesis may be caused in a different ways. Some examples are: |
- Developmental Spondylolisthesis
This type of spondylolisthesis may exist at birth, or may develop during childhood, but generally is not noticed until later in childhood or even in adult life
- Acquired Spondylolisthesis
Acquired spondylolisthesis can be caused in one of two ways: i. With all of the daily stresses that are put on a spine, such as carrying heavy items and physical sports, the spine may wear out (i.e., degenerate). As the connections between the vertebrae weaken, this may lead to a spondylolisthesis. ii. A single or repeated force being applied to the spine can cause a spondylolisthesis (i.e. spondylolytic) ; for example, the impact of falling off a ladder and landing on your feet, or the regular impact to the spine endured by offensive linemen playing football.
|
|
Sign/Symptoms |
| |
Many people with a spondylolisthesis will have no symptoms, and will only become aware of the problem when it is revealed on an x-ray for a different problem. However, there are several symptoms that often accompany spondylolisthesis: |
- Pain in the low back, especially after exercise.
- Increased lordosis (i.e., swayback).
- Pain and/or weakness in one or both thighs or legs.
- Reduced ability to control bowel and bladder functions.
- Tight hamstring musculature.
- In cases of advanced spondylolisthesis changes may occur in the way people stand and walk; for example, development of a waddling style of walking. This causes the abdomen to protrude further, due to the lowback curving forward more. The torso (chest, etc.) may seem shorter; and muscle spasms in the lowback may occur.
|
|
Treatment |
| |
Dependent on amount of slippage, severity of symptoms and age at time of diagnosis.
|
| |
Non Operative: |
- Decrease of activities
- Brace/Cast
- Muscle strengthening exercises
- Medications
|
| |
Periodic monitoring of symptoms and slippage, Surgery may be indicated if |
- A patient has not responded to the non operative treatment program
- There is a progressive slippage
- Muscle weakness or bowel or bladder symptoms develop severe slippage when first seen
|
|
Goals of Surgery |
| |
Prevent neurologic injury, diminish or eliminate low back and leg pain, and prevent or improve deformity. |
|
Reference Material |
| |
Kao-Wha Chang：Treatment L5 sever spondylolisthesis by total L5 resection, sacroplasty and crramfereatial. J orthop surg ROC 16：236-241, 1999。
 《Press the button to see the surgical example》
|
|
|
|
