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    Spondylolisthesis upload Spondylolisthesis upload Presentation Transcript

    • Spondylolisthesis
    • Herbinaux 1782Greek: Spondylo + olisthesis
    • DefinitionsSpondylolisthesis-Anterior or posterior slipping ordisplacement of one vertebra on another.Spondylolysis- dissolution of, or a defect in, the parsinterarticularis of a vertebra.Spondyloptosis-vertebra that is completely or essentiallycompletely dislocated.
    • EtiologyHereditary – DysplasticFailure of union of separate ossification centresBirth fracturesStress fracturesDegenerative changes
    • Classification
    • Wiltse McNab and NewmanMarchetti and Bartolozzi
    • PathophysiologyDysplasticCongenital defect in Hook or catchSecondary deformity
    • TraumaticExtension of Lumbar spinePars impactionRepetitive loading – pars fails
    • DegenerativeIntersegmental instability and remodellingIatrogenic
    • Incidence : 6%Racial : EskimosSpondylolysis 15-70 % 1stDeg relativesDysplastic more in FemalesLysis 2-3 times more in MalesSlip occur during growth spurt
    • Clinical features
    • Children: asymptomaticPostural/gait abn : Pelvic WaddleAdolescents: Activity related painTraumatic History in 40 %
    • LBAThigh/Leg - pain/WeaknessBowel/Bladder symptoms
    • Scoliosis- sciatic/olisthetic/idiopathicLumbar spine – foreshortening.Buttocks- heart shapedPhalen- Dickson sign
    • Step off signHamstring tightness.Tenderness over pars defectReduced lumbar movements.
    • Nerve root compressionCentral canal compressionB/B symptomsB/L Leg symptomsB/L SLR +Crossed SLR +
    • Investigations
    • Pelvic IncidenceSacral SlopePelvic tiltUllman sign
    • High dysplasticL5 - body TrapezoidS1 - Dome shapedSweet heart PelvisSacral verticalisationLumbosacral kyphosisCompensatory hyperlordosis
    • Bone ScanCTSPECTMRI
    • TreatmentConservativeSurgical
    • Factors affecting ProgressionCongenital alterationsSeverity of anatomic deficitsGrowthWeightbearingAge and Gender
    • Max slip- Spurt- 9-15 yrs< 10 yrs- monitor every 6 months till 15yrsthen every Yr till compl of growth
    • Asymptomatic upto 25 %No Treatment
    • SymptomaticRestActivity ModificationNSAIDSExercisesSteroid injectionsTLSO Brace
    • Surgical IndicationsProgression >25%High grade slip >50 %Intractable pain or Neuro deficitsProgressive postural/gait abn
    • Insitu fusionWith Autogenous graftRepair of Pars defectPedicle screwBone graftingSublaminar hookDecompressionLaminectomyRemove loose posterior element (Gill’s)
    • With instrumentationTLIFPLIFALIFCombined anterior and posterior
    • ComplicationsProgression of deformityIncreased slip anglePseudoarthrosisNeurologic injuriesA/c and delayed Cauda equinaBack pain and gait disturbances
    • Reduction: IndicationsSlip angle > 45 degLumbosacral kyphosisPostural imbalanceRequiring decompressionSlip progression after fusionUnacceptable appearance
    • SpondyloptosisVertebrectomyReduce L4 onto sacrumAnt + Post (Gaines)