undergraduates

1. Dr Kishore Vemula MS(ortho)
Senior Resident
Department Of Orthopaedics
Apollo Medical College,chittoor.
REGIONAL CONDITIONS OF SPINE
(SPONDYLOLISTHEIS)

2. Any Difference???

3. HISTORY
In 1782,Herbiniaux, A British Obstetritian Noted A Bone
Prominence Infront Of Sacrum That Caused Problems In Delivary
In 1854… Kilian Coined The Term Spondylolisthesis
Spondylo=spine
Olisthenein= Slip
Retrolisthesis( Backward Slip)

4. SPONDYLOLYSIS MEANS (APPG 2014)
1.Slip Of One Vertebra Over Its Caudal Vertebra
2. Defect Of Pars Interarticularis Causing Slip To Occur
3. Degenerative Condition Of Spine Charecterised By Disc Space
Narrowing, Osteophytes, Facet Arthropathy, Segmental Instability
4. Complete Forward Slip Of Vertebra Over Its Caudal Segment
(Complete Dissassociation Between Two Vertebra)

7. LISTHESIS
LYSIS
LOSIS OPTOSIS

8. NEWMANN CLASSIFICATION-- ETIOLOGICAL
• Lytic type 50%.... pars defects
• Dysplastic 20%.... Dysplasia of L5-S1 joint
• Degenerative 25%... Segmental instability due to age
• Post traumatic… defect in posterior elements other than pars
• Post surgical… excessive resection of posterior elements eg
laminectomy
• Pathological eg..multiple myeloma, infections

9. DYSPLASTIC TYPE
• < 20 Years
• Women Affects More
• Mostly Asymptomtic Resolves Before 20
Years
• L5-S1 Dysplasia Of Joint Surfaces
Leading To Slip
• Few Progress To Severe Neurological
Deficiencies

10. ISTHEMIC TYPE
• Most common type
• Age.. Adults
• ( sports activities)
• Mc site >> L5-S1
• Defect in pars

11. DEGENERATIVE TYPE
• Segmental Instability Due To Degeneration
• Mostly Asymptomatic
• Auto Stabilisation Occurs
• Common In Females
• Common In L4-L5 Area

13. HIGHER RISK OF SLIP PROGRESSION
• Females
• Young age
• High grade slip
• More slip angle
• Inclined or dome shaped sacrum
• Segmental instability in flextion and extension views

14. CLINICAL FEATURES
Mostly Asymptomatic
Low Back Ache … Mc Symptom
Muscle Spasms
Disc Bulges Or Tears
Compression Of Nerve Roots
May Progress To Severe Neurological Deficits
Bladder And Bowel Dysfunction

15. SIGNS
• Flat buttocks
• Absence of waist line
• lumbar hyperlordosis
• Transverse loin crease
• Palpation step sign

16. DIAGNOSIS
• X Rays
• Ap View … Napolean Hat Sign
• Lateral View
• Oblique Views… Scottish Dog With Collar Sign
• Flexion And Extension Lateral Views …
For Segmental Instability

17. INERTED NAPOLEAN HAT SIGN ON AP VIEW

18. OBLIQUE VIEWS .. SCOTTISH DOG WITH
COLLAR APPEARANCE

19. FLEXION AND EXTENSION VIEWS

20. • MRI
• SPECT … MOST SENSITIVE INVESTIGATION TO
FIND IMPENDING SPONDYLOLYSIS AND
PROGRESSION

21. MANAGEMENT
• Conservative
Rest, restriction of activities
brace for longer periods
Physio therapy

22. SURGERY .. INDICATIONS
• Severe neurological pain
• Neurological deficiencies
• Bladder and bowel disturbances
• High grade slip >50% with high risk of progression

23. OPERATIVE MANAGEMENT
Includes a combination of these proceedures…
• Decompression
• Pedicle screw fixation (stabilisation)
• Vertebral fusion

25. SUMMARY
• Listhesis means slip of vertebra
• Lysis means pars defect
• Mc type lytic type
• Mc in men ( dysplastic, degenarative common in females)
• Females more prone for progression
• Mostly asymptomatic
• Mostcommon symptom is LBA
• Step sign on palpation
• Scottish dog with collar on oblique views
• Severe pain,high grade slip, neurological defieciencies are indications of
surgery

26. Hope this is enough!!!!!
Thank
you ...