Spondylolisthesis upload

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Spondylolisthesis upload

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

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