2. Spondylolisthesis
Definition: Anterior or
posterior translational
displacement of one
vertebral body over
another.
Due to:
1. Trauma
2. Degenerative changes
3. Defects in the bony
architecture congenital
or pathological
3. Five part wiltse classification of the
etiology of spondylolisthesis
Type I
• Dysplastic
Spondylolisthesis :
secondary to a congenital
defect of either the
superior sacral or inferior
L5 facets or both with
gradual slipping of the L5
vertebra
4. Type II
• Isthmic or spondylolytic: the lesion is in the
isthmus or pars interarticularis,
spondylolysis :If a defect in the pars
interarticularis & no slipping.
Spondylolisthesis :If one vertebra has slipped
forward.
5. • Type II A: Lytic or stress
spondylolisthesis and is
most likely caused by
recurrent micro-
fractures caused by
hyperextension. It is
also called a "stress
fracture" of the pars
interarticularis and is
much more common in
males
6. • Type II B probably also
occurs from micro-
fractures in the pars.
However, in contrast to
Type II A, the pars
interarticularii remain
intact but stretched
out as the fracture fill
in with new bone
7. • Type II C is very rare
in occurrence and is
caused by an acute
fracture of the pars.
Nuclear imaging
may be needed to
establish diagnosis
8. Type III
• Degenerative spondylolisthesis,
and occurs as a result of the
degeneration of the lumbar facet
joints. The alteration in these
joints can allow forward or
backward vertebral displacement.
• Most often seen in older patients.
• There is no pars defect and the
vertebral slippage is never greater
than 30%
9. Type IV
• traumatic
spondylolisthesis, is
associated with acute
fracture of a posterior
element (pedicle,
lamina or facets)
other than the pars
interarticularis
10. Type V, pathologic
spondylolisthesis, occurs
because of a structural
weakness of the bone
secondary to a disease
process such as a tumor
or other bone diseases
11. Isthmic lysis
• The isthmic defect happens as a result of
compression caused by the lower articular
process of the superior vertebra on the
isthmic region in hyperlordosis
• The isthmus of L5 is more horizontal than
upper levels
12. • Lumbar hyperflexion
L5 is caught between
the L4 inferior and S1
articular surface
Resulting stress force on
pars interarticularis
13. • Isthemic lysis is due to
anterioposterior postural
imbalance and
secondary
spondylolisthesis is
readjacent mechanism
to adapt to postural
imbalance
14.
15. • Dysplastic forms
Slippage occurs at an age when growth is not
complete
Affecting growth of involved vertebrae
Vertebral elements exposed to excessive forces
growing less than non stressed vertebrae
16.
17. Traumatic Listhesis
• Traumatic listhesis is rare condition.
• Results from Acute fracture of the posterior
element other then pars interarticularis
• It is fracture dislocation of the spine involving all
three columns
• It is the shear forces which cause break in the
posterior stabilizers and the force is transmitted
at the level of Intervertebral disc resulting in
anterior or posterior displacement of the
vertebral body.
18. Degenrative
• Pathogenic
Degenerative destruction of posterior joints
Degenerative disc can nno longer maintain
vertebral relationship
Displacement occurs
Inferior joints of cephalad vertebrae contract and
expand due to instability of superior articular
process of inferior vertebrae
Compensatory hypertrophy
19.
20.
21. Diagnosis
• Step off sign at
adjacent spinous
process
• Tenderness on
midline
• Neurological signs
• Contracture of
quadriceps and
ischiocrural muscles
22. Treatment
Conservative management
• Immobilization with brace for 6 weeks
• Pain killers, anti inflammatory and injection
may limit pain but does not heal fracture
• Rehabilitation
• Sports like swimming will reduce the load on
disc
23. Surgical management
• Direct screw fixation
• Wire based or wire screw fixation
• Screwed hooks with compressive springe
• Hooks associated with pedicular screws
• Pedicular screws with bend rod
• Bicortical screw hooks with transverse connection
• Arthrodesis
