A lecture on spondylolysis fracture of the pars interarticularis of the spine.

1. Spondylolysis
Spine Conference
March 23rd, 2021

2. Spondylo-lysis
Spondylo-listhesis
Spondylo-sis
Isthmus
Pars Interarticularis

3. lysis

4. PARS INTERARTICULARIS

5. Isthmus of Kho Phi Phi

6. Spondylolysis
• 16 year old national
level club soccer
player club team with
LBP

16. How do you treat this patient?

18. 10 months later…..

23. 50% incidence among Inuit

26. Associated conditions
3 times greater incidence

27. Pelvic incidence
• Mean adult 57 deg
• >68.5 correlates to
slip

32. Radiographic Analysis of the Sagittal
Alignment and Balance of the Spine in
Asymptomatic Subjects
Raphaël Vialle, MD1; Nicolas Levassor,
MD1; Ludovic Rillardon, MD1;
Alexandre Templier, MD2; Wafa Skalli,
MD2; Pierre Guigui, MD1
1 Department of Orthopaedic Surgery,
Hôpital Beaujon, 100 Boulevard de
Général Leclerc, F-92110 Clichy,
France. E-mail address for R. Vialle:
ravialle@noos.fr
2 Department of Biomechanics,
ENSAM-PARIS, 151 Boulevard de
L'Hôpital, F-75013 Paris, France
View Disclosures and Other
Information
The Journal of Bone & Joint
Surgery. 2005; 87:260-
267 doi:10.2106/JBJS.D.02043

33. Reciprocal measurements T9S1
• S1 L5 L4 L3 L2 L1 T12 T11 T10
T9
• S1 0
• (0 to 0)
• L5 -23.3 -8
• (-24 to -22.5) (-8.5 to -7.5)
• L4 -40 -24.6 -2.6
• (-40.7 to -39) (-25 to -24) (-3 to -2.2)
• L3 -50.2 -34.9 -13 -0.6
• (-51.2 to -49.3) (-35.8 to -34) (-13.6 to -12.4) (-0.9 to -0.3)
• L2 -57 -41.5 -19.50 -7.2 1.2
• (-58 to -55.7) (-42.6 to -40) (-20.5 to -19) (-7.7 to -6.6) (0.8 to 1.5)
• L1 -58.5 -43 -21 -8.8 -0.45 3.8
• (-60 to -57) (-44.4 to -42) (-22.3 to -20.2) (-9.7 to -8) (-1 to 0) (3.5 to 4)
• T12 -57.2 -42 -20 -7.5 0.8 5.1 4.5
• (-58.5 to -56) (-43 to -40) (-21 to -19) (-8.5 to -6.6) (0 to 1.6) (4.5 to 5.6) (4.1 to 4.8)
• T11 -54 -38.8 -17 -4.5 4 8.2 7.6 4.8
• (-55.5 to -53) (-40 to -37) (-18 to -16) (-5.6 to -3.5) (3 to 5) (7.4 to 9) (7 to 8) (4.5 to 5)
• T10 -52 -36.5 -14.5 -2.2 6.20 10.50 10 7 3
• (-52 to -54) (-38 to -35) (-16 to -13) (-31 to -1) (5 to 7) (10 to 11) (9 to 10.5) (6.5 to 7.5) (2.6 to 3.2)
• T9 -49 -33.7 -11.8 0.6 9 13.3 12.7 10 5.7
3.5
• (-50 to -48) (-35 to -32) (-13 to -10) (-0.5 to 1.7) (8 to 10) (12.5 to 14) (12 to 13) (9 to 10.5) (5.3 to 6.2) (3 to 3.7)

35. First Degree relatives

36. 4% progress to spondylolisthesis

39. Imaging
• Xrays
• CT
• MRI
• Bone scan

43. • Pedicle
edema

49. Osteiod osteoma

50. • A: Buck direct screw
• B: Scott wiring technique
• C: Kakiuchi screw with laminar hook

51. • Pedicle
screw with
infralaminar
hook

52. Direct interlaminar screw repair

57. 61 year old man with right sciatica for several months with 2
opinions for L5S1 posterior spinal fusion finds a friend on the golf
course that did extremely well with decompression surgery SH
avid golfer retired fireman very healthy married

63. 30 man R>L LBP, pain L hip numbness anterior thigh, SH: IT
analyst PE: 5’8” 175 lb

71. Thanks!