Section 7 - Spondylolisthesis

Question 1

What is type I of Spondylolisthesis?

Answer 1

Dysplastic (Formally called congenital) Spondylolisthesis usually occurs at L5-S1 and is caused by a congenital defect in the sacral articulated processes (sacral horns) or in the posterior elements of the L5 vertebra. This allows the L5 vertebra to slip forward on the sacrum.

Question 2

What is type II of Spondylolisthesis?

Answer 2

Isthmic is caused by a defect or fracture in the pars interarticularis area of the lamina and is the most common type of Spondylolisthesis. Type II is subdivided into 3 sub categories

Question 3

What is type IIA of Spondylolisthesis?

Answer 3

Sometimes called lytic or stress Spondylolisthesis and is most likely caused by recurrent micro-fractures in the pars interarticularii from hyperextension. Involves a complete separation of the posterior elements from the vertebral body. Also known as stress fracture of the pars and is much more common in males. Gymnasts, weight lifters and football linemen have a higher incidence of Type IIA b

Question 4

What is type II B of Spondylolisthesis?

Answer 4

Probably also occurs from micro-fractures in the pars. However, in contrast to Type IIA, the pars interarticularii remain intact but becomes elongated as the fracture fill in with new bone. The progressive lengthening of the pars allows the body to slide forward. Eventually when the anterior and posterior elements are divided a Type IIB will become a Type IIA

Question 5

What is type II C of Spondylolisthesis?

Answer 5

Occurs very rarely and is caused by an acute fracture of the pars. It may be difficult to differentiate a Type II C from a Type II A. Acute fracture of the pars but no fibrous tissue

Question 6

What is type III of Spondylolisthesis?

Answer 6

Most commonly occurs at L4-5 and is the result of degenerative changes in the facet joints. No abnormalities of the pars interarticularis. Also, the L4-5 disc becomes markedly degenerated, resulting in hypermobility of the motion segment. L5 nerve root is often compressed in Type III.

Question 7

What is type IV of Spondylolisthesis?

Answer 7

Also called traumatic Spondylolisthesis, results from a fracture of the vertebrae in some area other than the pars. These fractures may be in the pedicles, lamina, or facets.

Question 8

What is type V of Spondylolisthesis?

Answer 8

Is a pathologic Spondylolisthesis caused by tumor or a metabolic type of bone disease.

Question 9

What is type VI of Spondylolisthesis?

Answer 9

An iatrogenic Spondylolisthesis is usually caused by excessive surgical decompression or the posterior element.

Question 10

Low dysplastic Spondylolisthesis

Answer 10

Has a translational shift of one vertebrae.

Question 11

High Dysplastic Spondylolisthesis

Answer 11

Has significant segmental kyphosis associated with the kyphosis.

Question 12

Which Wiltse type does the following picture represent?

Answer 12

Type I

Question 13

Which Wiltse type does the following picture represent?

Answer 13

Type II-A

Question 14

Which Wiltse type does the following picture represent?

Answer 14

Type II-B

Question 15

Which Wiltse type does the following picture represent?

Answer 15

Type II-C

Question 16

Which Wiltse type does the following picture represent?

Answer 16

Type III

Question 17

Which Wiltse type does the following picture represent?

Answer 17

Type IV

Question 18

Which Wiltse type does the following picture represent?

Answer 18

Type V

Question 19

Using the Meyerding Grading System, what grade slip is the following picture?

Answer 19

Grade 1

less than 25% translation

Question 20

Using the Meyerding Grading System, what grade slip is the following picture?

Answer 20

Grade II

25-49% translation

Question 21

Using the Meyerding Grading System, what grade slip is the following picture?

Answer 21

Grade III

50-74% translation

Question 22

Using the Meyerding Grading System, what grade slip is the following picture?

Answer 22

Grade IV

75-99% translation

Question 23

Using the Meyerding Grading System, what grade slip is the following picture?

Answer 23

Grade V

Body slipped off the level below.

Also known as Spondyloptosis.

Question 24

____________________ Method

Answer 24

Standard Slip Angle Method

Question 25

____________________ Method

Answer 25

Slip Angle Method

(When inferior L5 end plate is irregularly shaped or when sacrum is dome shaped)

Question 26

____________________ Method

Answer 26

Sacral Inclination Method

Question 27

Describe “tilt” and “slip” as those terms relate to the Modified Newman Method

Answer 27

Slip = Measured from the posterior inferior angle of the body perpendicular tot he sacral end plate line.

Tilt = Measured from the anterior inferior corner of the vertebrae perpendicular to the line on the anterior surface of the sacrum.