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Case of Grade 2 Anterolisthesis at C2-C3 C4-C5

Ulmer and colleagues proposed the "wide canal sign" to distinguish between isthmic anddegenerative spondylolisthesis. Using a midline sagittal section, they noted that the sagittal canalratio (maximum anteroposterior diameter at any level divided by the diameter of the canal at L1) didnot exceed 1.25 in normal controls and in subjects with degenerative spondylolisthesis. In patientswith spondylolysis, the measurement always exceeded 1.25.

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The sagittal plane is best fordisplaying the abnormal anatomy ofspondylo-listhesis, T2-weighted imagesfor the canal and T1-weighted images forthe pars interarticularis and neuralforamina. The sagittal view clearlyshows the degree of subluxation and therelationship of the intervertebral disk tothe adjacent vertebral bodies and thespinal canal. Parasagittal images aregood for showing encroachment on theforamina by disk or hypertrophic bone. Loss of the normal fat signal cushioningthe nerve root is a sign for significantforaminal stenosis.

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Spondylolysis (spon-dee-low-lye-sis) and spondylolisthesis (spon-dee-low-lis-thee-sis) are separate, yet related conditions. Spondylolysis usually comes first, though not always. The term comes from "spondylo," which means "spine," and "lysis," which means to divide. Spondylolysis is a breakdown or fracture of the narrow bridge between the upper and lower facets, called the pars interarticularis. It can occur on one side (unilateral) or both sides (bilateral) and at any level of the spine, but most often at the fourth or fifth lumbar vertebra (Fig. 2). If spondylolysis is present, then you have the potential to develop spondylolisthesis.

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