(3) Degenerative, Traumatic, Patho, Spondylolisthesis Flashcards
What is meant by degenerative spondylolisthesis?
slippage due to of facet or disc degeneration, with neural arch intact
(degeneration changes orientation of facets, allowing slippage)
What is the most common level of degenerative spondylolisthesis?
L4
What demographic has an increased frequency of degenerative spondylolisthesis?
- 40+ yrs
- female
- L4
What is the most significant concern of degenerative spondylolisthesis?
central stenosis & neurogenic claudication
Degenerative spondylolisthesis in what spinal region is of greater clinical concern?
c/s > l/s
What is the typical grade of degenerative spondylolisthesis?
unusual to progress beyond grade 1 anterolisthesis
What is meant by traumatic spondylolisthesis?
slippage d/t trauma:
- acute Fx of posterior arch NOT involving pars
- hangman Fx (through pedicles)
- bilateral facet dislocation
What is meant by pathologic spondylolisthesis?
underlying bone disease results in weakening, allowing Fx of pars
(eg. osteoporosis, mets, pagets, osteopetrosis, etc)
What spondylolisthesis classification term should not be used?
iatrogenic
What radiographic views should be used to visualize spondylolisthesis?
- AP, lateral first
- obliques
- Fergusons (L5)
What radiographic views/positions should be used to assess stability of spondylolisthesis?
- F/E (l/s recumbent, c/s standing)
- traction/compression (not practical)
How much translation must occur in the lumbar spine to determine instability?
4.5mm
How much translation must occur in the cervical spine to determine instability?
3.5mm
How much angular motion must occur in the lumbar spine to determine instability?
> 11 deg
What are the options for management of a stable/inactive spondylolisthesis?
- chiro. manipulation
- biomech. evaluation (pelvis & LE)
- rehab. exercises
What are the options for management of an unstable spondylolisthesis?
- Boston brace (acute; PMNR referral)
- surgical arthrodesis (chronic)
What is another name for a Boston brace?
Thoracolumbosacral orthosis (TLSO)
What structure may implicated if C1 moves forwards (^ADI)?
transverse ligament (DDx 26+) OR dens (3 DDx)
What structure may be implicated if C1 moves posteriorly?
odontoid/dens (3 DDx)
