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There are five types of spondylolisthesis
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.
In traumatic spondylolisthesis, any part (usually not the pars) of the neural arch can be fractured, leading to the unstable vertebral subluxation.
spondylolisthesis: when one vertebra slips forward on another.
Pathologic spondylolisthesis results from generalized bone disease, which causes abnormal mineralization, remodeling, and attenuation of the posterior elements leading to the slip.
In 2014, the French Society for Spine Surgery proposed a classification of degenerative spondylolisthesis that comprised the following five types :
We treat more than 600 patients with spondylolisthesis each year.
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.
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.
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Spondylolisthesis - PhysioWorks
In degenerative spondylolisthesis, intersegmental instability is present as a result of degenerative disk disease and facet arthropathy. These processes are collectively known as spondylosis (ie, acquired age-related degeneration). The slip occurs from progressive spondylosis within this three-joint motion complex. This typically occurs at L4-5, and elderly females are most commonly affected. The L5 nerve root is usually compressed from lateral recess stenosis as a result of facet and/or ligamentous hypertrophy.
What Causes a Spondylolisthesis
Biomechanical factors are significant in the development of spondylolysis leading to spondylolisthesis. Gravitational and postural forces cause the greatest stress at the pars interarticularis. Both lumbar lordosis and rotational forces are also believed to play a role in the development of lytic pars defects and the fatigue of the pars in the young. An association exists between high levels of activity during childhood and the development of pars defects. Genetic factors also play a role.
Isthmic vs Degenerative Spondylolisthesis
Spondylolysis and spondylolisthesis are conditions affecting the joints that align the vertebrae one on top of the other. Spondylolysis is a weakness or stress fracture in the facet joint area. This weakness can cause the bones to slip forward out of normal position, called spondylolisthesis, and kink the spinal nerves. Treatment options include physical therapy to strengthen the muscles. A back brace may be used to support the spine. In some cases, surgery can realign and fuse the bones.
Read our article and learn more on MedlinePlus: Spondylolisthesis
A unilateral pars defect (spondylolysis) may not demonstrate any degree of slippage; thus, a patient may have spondylolysis without spondylolisthesis. The reverse is also true as in the degenerative-type slips described below.
Spondylolysis and spondylolisthesis - Mayfield Clinic
Lumbar fusion is being performed with more frequency across the United States, with considerable regional variation. These variations have been attributed to a multitude of factors, from advancements in instrumentation to the understanding of bone healing. Lack of clearly defined indications for fusion has been another contributing factor. The evidence in support of fusion for spondylolistheses types I, II, IV, and V and iatrogenic spondylolisthesis is strong. Some controversy exists regarding persons with degenerative-type slips (type III), degenerative scoliosis, and mechanical back pain.
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