The etiology of pediatric spondylolysis is multifactorial. In pediatric patients, dysplastic causes and isthmic defects are the predominant causes of spondylolisthesis. Spondylolisthesis due to bilateral intervertebral pars fracture is also called isthmic spondylolisthesis or spondylolytic spondylolisthesis. This article focuses on pediatric and adolescent spondylolysis and spondylolisthesis. Spondylolisthesis can occur due to a variety of etiologies.

Grade V: greater than 100% (also termed spondyloptosis).

Five grades are included in the Meyerding classification system: The extent of slipping is considered a major prognostic factor. 5 This quantifies the degree of slippage of one vertebral body on another on a standing neutral lateral radiograph of the lumbar spine. Meyerding described the first grading of spondylolisthesis in 1932. Spondylolisthesis of L5 over the sacrum was first described by Herbinaux in 1782 3, but Kilian was the first to use the term spondylolisthesis in 1854 4. This is known as spondylolisthesis and refers to forward translation of one vertebral segment over the one beneath it. With spondylolysis, slippage of one vertebra on another may occur. 1 Unilateral pars defects do not typically progress to spondylolisthesis. Spondylolysis may be unilateral or bilateral and occurs almost exclusively in the lumbar spine with L5 level being most often. Spondylolysis refers to a defect or fracture of the vertebral pars interarticularis. Putting things back to normal alignment is often possible as well.The terms spondylolysis and spondylolisthesis are derived from the Greek roots “spondylos” meaning vertebrae, “lysis” meaning loosening, and “olisthesis” meaning slippage or dislocation. If there is slippage, the two main goals are unpinching the nerves and internally stabilizing the spine. In younger people without a slip, surgery may be used to directly repair the pars defect in older people or in those with some degree of instability, a spinal fusion may be required. Anti-inflammatory cortisone injections may also be of help.įor people with spondylolysis, surgery to repair the defect in the pars interarticularis is needed only after non-surgical measures such as physical therapy and exercises have failed to relieve symptoms. Braces are rarely needed but may be helpful in reducing your symptoms. If you have significant leg pain, you can also take an anti-inflammatory medication.

A physical therapist is often helpful in getting you back on your feet and can instruct you in the proper way to do these exercises without making your symptoms worse. The non-surgical treatments for spondylolysis and spondylolisthesis are most commonly rest, followed by trunk and abdominal strengthening exercises.

This is a special situation that is called a spondyloptosis and is very rare. Grade V: This means that the upper vertebral body has slid all the way forward off the front of the lower vertebral body.

Grade III: Between 50 and 75 percent slip.Grade II: Between 25 and 50 percent slip.Spondylolisthesis is graded according to the amount that one vertebral body has slipped forward on another: People with a dysplastic pars have an elongated interarticular region along with altered pedicles. Spondylolisthesis is most easily seen on the lateral and oblique views of the spine, but in some cases, specialized imaging studies such as a bone scan or CT scan (CAT scan) are needed to make the diagnosis. Plain x-rays of the lumbar spine are initially best for diagnosing spondylolysis or spondylolisthesis. Often, the first physical sign of spondylolisthesis is tightness of the hamstring muscles in the legs. Many people with spondylolisthesis will have vague symptoms and very little visible deformity.

Pars defect with spondylolisthesis