Isthmic Spondylolisthesis

Question 1

What is isthmic spondylolisthesis

Answer 1

1. Similar to degenerative spondylolisthesis except
   *bony defect is present in the pars interarticularis
   *L5-S1 MC

Question 2

What is the causes of isthmic spondylolisthesis

Answer 2

Due to stress/fatigue fractures that do not heal adequately

Question 3

What is the clinical presentation of isthmic spondylolisthesis

Answer 3

Often asymptomatic
Back pain radiating to or below the knees

Question 4

What is on the PE

Answer 4

1. Decreased lumbar lordosis / flattened butt
2. Step off deformity
3. Spasms of hamstrings

Question 5

What tests to order

Answer 5

Radiographs
1. Lateral (show forward translation of affected vertebrae)
2. Oblique (shows pars defect breaks the the Scotty dogs neck)

Question 6

What is the treatment

Answer 6

1. Surgical stabilization if skeletal immature (if skeletally mature only if patient has failed conservative treatment)
2. Conservative treatment
   *NSAIDs
   *rarely progress as an adult