Spondylolisthesis

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Spondolytic%20Spondylolisthesis/spondylocorrect.htm
Normally the inferior articulating fact of each lumbar vertebral body lies posterior to the
superior articulating facet of the body below it
If the bony connection between the inferior and superior articulating facets (pars
interarticularis) is defective, the weight of the body may cause the upper vertebra, including all of
the vertebral bodies above it, to slip forward for varying amounts on the body below
(spondylolisthesis)
The defect in the pars interarticularis is called spondylolysis
Spondylolysis is not present at birth but increases in frequency with increasing age
When symptomatic, pain is the most frequent symptom of either spondylolysis or
spondylolisthesis
There are several different etiologies for spondylolisthesis
o Spondylolytic spondylolisthesis
Is the most common type and results from bilateral defects in the pars interarticularis
Has a 2:1 male to female predominance and is more common in Caucasians than African-
Americans
With bilateral spondylolysis, the posterior aspect of vertebral body separates from the
anterior body
Posterior body remains fixed in position while the anterior part is free to slip forward
Cause of spondylolysis appears to be a combination of a dysplastic pars at birth coupled with
the long-term stresses of upright posture
Certain athletic endeavors (e.g., football, weight-lifting, tennis and wrestling) appear to
increase these stresses
Fractures of the pars may heal with a pseudarthrosis or fibrous ankylosis
o Degenerative spondylolisthesis
More common in African American women than in Caucasian women
Most frequent at the L4-L5 level
Is not the result of a pars defect but a complex interaction between the disk, facets joints and
the ligamentous structures
There is usually narrowing, sclerosis of the facet joints from osteoarthritis
There is less forward slippage (spondylolisthesis) in this group than in spondylolytic group
Retrolisthesis (backward slippage of a vertebral body on the body below it) may occur with
osteoarthritis of the facets joints
o Dysplastic spondylolisthesis
Results from congenital abnormalities of the body and/or facets in the lumbar region such
that the alignment of the facets allows spondylolisthesis to occur
The pars may or may not be intact
Females are more apt to have this type than males (2:1)
Symptoms usually develop during the adolescent growth period
o Traumatic spondylolisthesis
Trauma can lead to an acute fracture through a normal pars interarticularis
Results in a diastatic defect that may lead to a spondylolisthesis
Imaging findings
o Conventional radiography in the anteroposterior, lateral and both oblique projections is usually
adequate to demonstrate both spondylolysis and spondylolisthesis
o Spondylolysis appears as a break in the neck of the Scottie Dog on the oblique view
o Bilateral spondylolysis is visible on the lateral view
o Forward slippage of one vertebral body on the other is observed and graded on the lateral view
o Spondylolisthesis is graded in this manner
Grade 1-vertebral body above subtends of the AP diameter of the vertebral body below
Grade 2- vertebral body above subtends 1/2 of the AP diameter of the vertebral body below
Grade 3- vertebral body above subtends 3/4 of the AP diameter of the vertebral body below
Grade 4- vertebral body above subtends the full AP diameter of the vertebral body below



Spondylolytic Spondylolisthesis. Lateral view of the lumbar spine demonstrates
a bilateral break in the pars interarticularis or spondylolysis (lucency shown by black arrow)
that allows the L5 vertebral body (red arrow) to slip forward on the S1 vertebral body (blue arrow).
The forward slippage is called spondylolisthesis. The normal pars interarticularis is shown by the
white arrow.
the degree of forward slippage is equal to about 1/4 to 1/2 of the AP diameter of S1
so this is a Grade1-Grade 2 spondylolisthesis.