Case Review #1: 16 year old with Isthmic Spondylolisthesis Grade IV

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16 year old female diagnosed with Isthmic Spondylolisthesis. The patient experience back pain and leg pain, and under went a lumber fusion.

Health & Medicine Technology

Isthmic
Spondylolisthesis
Grade IV:

Treated with an
anterior and posterior
spinal fusion

Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

Grade IV Isthmic Spondylolisthesis

16 year old female
Documented progression of
Spondylolisthesis from 2002 to 2003
L5 weakness of left foot
Low back and leg pain

Sagittal Rotation

Sagittal Rotation
17o

Sacral Inclination

50o

Sacral Inclination

Surgical Plan

• Laminectomy L5
• Bilateral foraminotomy L5-S1
• L5-S1 Microdisectomy
• Spondylolisthesis reduction
• Anterior interbody fusion at L4-S1
• Posterior fusion L4-S1

Surgical Treatment

ASF Subtotal Vertebrectomy and Reduction

Post Surgery

The patient’s symptoms were resolved following surgery.

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Spondylolisthesis is a spinal condition characterized by the displacement of one vertebra over another. This condition commonly affects the lower back, specifically the lumbar spine. The misalignment can occur as a result of various factors, including developmental issues, degenerative changes, trauma, or stress fractures.There are different types of spondylolisthesis, each with its own distinct causes and characteristics: Congenital Spondylolisthesis: This type of spondylolisthesis is present at birth and occurs due to abnormalities in the formation of the spine. Isthmic Spondylolisthesis: Isthmic spondylolisthesis is caused by a defect or stress fracture in the pars interarticularis, a small bridge of bone connecting the upper and lower facets of a vertebra. Degenerative Spondylolisthesis: As the name suggests, degenerative spondylolisthesis develops as a result of age-related wear and tear on the spine, such as the breakdown of intervertebral discs and the facet joints. Traumatic Spondylolisthesis: Trauma or injury to the spine can lead to traumatic spondylolisthesis, causing the vertebrae to shift out of alignment. Pathological Spondylolisthesis: Pathological spondylolisthesis occurs when a bone-weakening disease, such as osteoporosis or bone cancer, weakens the spinal vertebrae, leading to slippage. Symptoms of Spondylolisthesis The symptoms of spondylolisthesis can vary depending on the severity of the condition and the affected spinal region. Common symptoms include: Lower back pain that may radiate to the buttocks or legs Muscle tightness or stiffness in the back Weakness or numbness in the legs Difficulty walking or performing daily activities Loss of bladder or bowel control (in severe cases)Diagnosing Spondylolisthesis If spondylolisthesis is suspected, a thorough medical evaluation and diagnostic tests will be conducted. These may include: Medical History and Physical Examination: A comprehensive review of the patient's medical history, along with a physical examination to assess symptoms, range of motion, and nerve function. Imaging Tests: X-rays, magnetic resonance imaging (MRI), or computed tomography (CT) scans can provide detailed images of the spine, helping to identify the degree of vertebral slippage and any associated structural abnormalities. Bone Scans: In some cases, bone scans may be performed to detect stress fractures or other abnormalities in the bones. Nerve Studies: Electromyography (EMG) and nerve conduction studies may be recommended to assess nerve function and identify any nerve compression or damage.Here are some common treatment options for spondylolisthesis: Conservative Treatments: Rest and Activity Modification: Taking a break from activities that exacerbate symptoms and adopting modifications in daily routine to reduce stress on the spine. Physical Therapy: Targeted exercises and stretches under the guidance of a physical therapist to improve strength, flexibility, and stability of the back

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