1. Spondylolisthesis

2. Herbinaux 1782
Greek: Spondylo + olisthesis

3. Definitions
Spondylolisthesis-Anterior or posterior slipping or
displacement of one vertebra on another.
Spondylolysis- dissolution of, or a defect in, the pars
interarticularis of a vertebra.
Spondyloptosis-vertebra that is completely or essentially
completely dislocated.

5. Etiology
Hereditary – Dysplastic
Failure of union of separate ossification centres
Birth fractures
Stress fractures
Degenerative changes

6. Classification

7. Wiltse McNab and Newman
Marchetti and Bartolozzi

10. Pathophysiology
Dysplastic
Congenital defect in Hook or catch
Secondary deformity

11. Traumatic
Extension of Lumbar spine
Pars impaction
Repetitive loading – pars fails

12. Degenerative
Intersegmental instability and remodelling
Iatrogenic

13. Incidence : 6%
Racial : Eskimos
Spondylolysis 15-70 % 1st
Deg relatives
Dysplastic more in Females
Lysis 2-3 times more in Males
Slip occur during growth spurt

14. Clinical features

15. Children: asymptomatic
Postural/gait abn : Pelvic Waddle
Adolescents: Activity related pain
Traumatic History in 40 %

16. LBA
Thigh/Leg - pain/Weakness
Bowel/Bladder symptoms

17. Scoliosis- sciatic/olisthetic/idiopathic
Lumbar spine – foreshortening.
Buttocks- heart shaped
Phalen- Dickson sign

18. Step off sign
Hamstring tightness.
Tenderness over pars defect
Reduced lumbar movements.

19. Nerve root compression
Central canal compression
B/B symptoms
B/L Leg symptoms
B/L SLR +
Crossed SLR +

21. Investigations

27. Pelvic Incidence
Sacral Slope
Pelvic tilt
Ullman sign

28. High dysplastic
L5 - body Trapezoid
S1 - Dome shaped
Sweet heart Pelvis
Sacral verticalisation
Lumbosacral kyphosis
Compensatory hyperlordosis

29. Bone Scan
CT
SPECT
MRI

30. Treatment
Conservative
Surgical

31. Factors affecting Progression
Congenital alterations
Severity of anatomic deficits
Growth
Weightbearing
Age and Gender

32. Max slip- Spurt- 9-15 yrs
< 10 yrs- monitor every 6 months till 15yrs
then every Yr till compl of growth

33. Asymptomatic upto 25 %
No Treatment

34. Symptomatic
Rest
Activity Modification
NSAIDS
Exercises
Steroid injections
TLSO Brace

35. Surgical Indications
Progression >25%
High grade slip >50 %
Intractable pain or Neuro deficits
Progressive postural/gait abn

36. Insitu fusion
With Autogenous graft
Repair of Pars defect
Pedicle screw
Bone grafting
Sublaminar hook
Decompression
Laminectomy
Remove loose posterior element (Gill’s)

37. With instrumentation
TLIF
PLIF
ALIF
Combined anterior and posterior

38. Complications
Progression of deformity
Increased slip angle
Pseudoarthrosis
Neurologic injuries
A/c and delayed Cauda equina
Back pain and gait disturbances

39. Reduction: Indications
Slip angle > 45 deg
Lumbosacral kyphosis
Postural imbalance
Requiring decompression
Slip progression after fusion
Unacceptable appearance

40. Spondyloptosis
Vertebrectomy
Reduce L4 onto sacrum
Ant + Post (Gaines)