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Explaining Spinal Disorders: Isthmic Spondylolisthesis

As in all corrections of subluxations, finding the right adjustment and table is critical. When an L5 subluxation and spondylolisthesis is found, it is common to adjust the sacrum as a side posture, pisiform push move. There are many cases where the Hylo table (prone table) or knee chest table is the most effective.

Some use etiology and classify spondylolisthesis as acquired or developmental. (1)

There are several forms of surgery that have been advocated for the treatment of high-grade isthmic spondylolisthesis, including posterior interlaminar fusion, in situ posterolateral fusion, in situ anterior fusion (ALIF), in situ circumferential fusion, instrumented posterolateral fusion, and surgical reduction with instrumented posterolateral interbody fusion (PLIF). Advocates of these different techniques all cite specific advantages of each approach, but they all have established risks and some are much more complication-prone than others.

Explaining Spinal Disorders: Degenerative Spondylolisthesis

18. Taillard WF. Etiology of Spondylolisthesis. Clin Orthop Rel Res. June 1976; 117:30-39

Some surgeons attempt to reduce the spondylolisthesis in order improve the overall sagittal alignment and spinal biomechanics. This has the benefit of improving standing posture and placing less strain on the posterior fusion mass and spinal hardware reducing the incidence of nonunion and spondylolisthesis progression. The quoted rate of transient or permanent nerve-root injury associated with reduction is 5-30%.

In a study by Schaeren et al, decompression and dynamic stabilization showed excellent results, after a follow-up of at least 4 years, in elderly patients with spinal stenosis and degenerative spondylolisthesis. Patient satisfaction was high, with 95% stating they would undergo the procedure again.[3]

Spondylolysis and Spondylolisthesis - OrthoInfo - AAOS

1. Antoniades SB. Hammerberg KW, DeWald RL. Sagittal Plane Configuration of the Sacrum in Spondylolisthesis. Spine 2000; 25(9):1085-1091.

As the understanding of spinal instability and biology of bone healing increases, we will be able to better define the population of patients with spondylolisthesis who would benefit most from lumbar fusion or particular methods of fusion and fixation.

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.

6. Floman Y. Progression of Lumbosacral Isthmic Spondylolisthesis in Adults. Spine 1 Feb 2000; 25(3):342-347.
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Adult Isthmic Spondylolisthesis - Spine - Orthobullets

The most common grading system for spondylolisthesis is the Meyerding grading system for severity of slip. The system categorizes severity based upon measurements on lateral X-ray of the distance from the posterior edge of the superior vertebral body to the posterior edge of the adjacent inferior vertebral body. This distance is then reported as a percentage of the total superior vertebral body length:

Spondylolisthesis Exercises That Really Work To Ease Pain

Degenerative spondylolisthesis is a disease of the older adult that develops as a result facet arthritis and facet remodeling. As the facets remodel, they take on a more sagittal orientation, allowing a mild slip to occur. These slips are very common, a study of osteoporosis found a 30% incidence among Caucasian women older than 65 years and a 60% incidence among African-American women older than 65 years. Most slips are asymptomatic, but can worsen the symptoms of neurogenic claudication when associated with lumbar]]spinal stenosis[[. Degenerative spondylolisthesis with spinal stenosis is one of the most common indications for spine surgery among older adults and current evidence suggests that patients have much better success rates and more clinical benefit with decompression and fusion than decompression alone.

Spondylolisthesis: Everything you ever wanted to know, …

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.

Spondylolisthesis: Everything you ever wanted ..

Traumatic spondylolisthesis is very rare and may be associated with acute fracture of the inferior facets or pars interarticularis. It is treated in the same manner as other spinal fractures and there are only a handful of case reports on this type.

Spondylolisthesis, Spondylolysis, and Spondylosis

Isthmic spondylolisthesis is the most common form of spondylolisthesis. Isthmic spondylolisthesis (also called spondylolytic spondylolisthesis) is a common condition with a reported prevalence of 5%-7% in the U.S. population. Fredrickson, et al demonstrated that the spondylolytic defect is usually acquired between the ages of 6 and 16 years, and that the slip often occurs shortly there after. Once the slip has occurred, it rarely continues to progress, although one study did find an association between disc desiccation and slip progression during middle-age. It is though that the vast majority of isthmic slips do not become symptomatic, but the incidence of symptoms is unknown. One very long-term prospective study by Fredrickson, et al that followed a cohort of 22 patients from the development of their slip into middle-age, reported that many of the patients experienced occasional back pain, but so does the vast majority of people without isthmic spondylolisthesis. One patient did undergo]]spinal fusion[[at the slipped level, but the study could not verify if the isthmic slip was the indication for surgery. Roughly 90% of isthmic slips are low-grade(less than 50% slip) and 10% are high-grade (greater than 50% slip).

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