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Spine FRCS > Spondylolisthesis > Flashcards

Spondylolisthesis Flashcards

1
Q

What is spondylolisthesis?

A

Forward slippage of one vertebra on another

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2
Q

Can you name the types of spondylolisthesis?

A

*DYSPLASTIC - CHILD- congenital dysplasia S1 sup facet *ISTHMIC - 5-50 - predipostn->elongatn/fracture pars L5-S1 *DEGENERATIVE - >40-facet arthrosis->subluxL4/5 *TRAUMATIC - any age- acute fracture other than pars *PATHOLOGICAL- any age- incompetence of bony elements POSTSURGICAL- adult- excessive resection of neural arches/facets DID TOMMY PAST POINT!!!

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3
Q

Whose’s classification is that?

A

NEWMAN, WILTSE AND MCNAB

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4
Q

How is the severity of the slip classified?

A

Based on the amount/ degree compared with S1 width

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5
Q

Can you describe this severity score?

A

Grade I- 0-25% Grade 2- 25-50% Grade 3 50-75% Grade 4 >75% Grade V- >100% = SPONDYLOPTOSIS

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6
Q

Whose’ grading system is this?

A

MEYERDING

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7
Q

What other measurements can be made to quantify the slippage? Can you describe how is it measured?

A

The slip angle it is measured from the superior border of L5 and a perpendicular line from the post edge of the sacrum

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8
Q

What is the natural hx of the disorder ?

A

unilateral pars defects almost never slip and that porgession of SPONDYLOLITHESIS slows over time yet in adulthood DEGENERATION AND NARROWING of the disc - usually L5/S1 are common-> narrowing of neural foramen and compression of exciting L5 root that -> radicular symptoms

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9
Q

How do children present with spondylolithesis?

A

Back pain- >25% slip, or l4-5, L3-4 spondylolitheis higher rate of pain cf general population hamstring tightness Palpable step off Alteration in gait- waddle severe slips rare- assoc radiculopathy l5

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10
Q

What is the age and gender of presentation of a child with spondylolithesis?

A

Age 4-6 > in white boys who participate in hyperextension activities > some eskimo tribes

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11
Q

What level is normally effected in a child with spondylolithesis?

A

L5-S1

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12
Q

What is its aetiology?

A

SHEAR STRESS at the PARS INTERARTICULARIS associated with repetitive hyperextension.

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13
Q

Children with the dysplastic type of spondylolithesis are at risk of what?

A

higher risk of SLIP PROGRESSION and development of CAUDA EQUINA DYSFUNCTION as the NEURAL ARCH IS INTACT

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14
Q

What conditions have been associated with spondylolithesis?

A

SPINA BIFID OCCULTA THORACIC HYPERKYPHOSIS SCHEUERMANN DISEASE

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15
Q

What is the treatment of low grade spondylolithesis (<50% slip)?

A

USUALLY RESPONDS TO NON OP TX= ACTIVITY MODIFICATIONS EXERCISE grade I can return to sport when symptomatic grade II are restricted from football/gymnastics

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16
Q

What are the risk factors for progression?

A

Young age at presentation female gender- a slip angle of >10degrees dome shpaed or inclined sacrum

17
Q

What would surgery for a low grade slip involve?

A

L5-S1 postrolateral fusion INSITU for those with intractable pain in whom non op failed or further slippage

18
Q

What spondylolithesis (grades III-IV) present with ?

A

Neruological abnormalities L5-S1 isthmic spondylolithesis -> L5 radiculopathy (cf s1 radiculopathy in L5S1 HNP)

19
Q

What is the treatment of high grade spondylolithesis?

A

Prophylastic FUSION in growing children with slippage >50% Usually requires INSITU BILATERAL POSTEROLATERAL FUSION L4-S1 WITH OR WITHOUT INSTRUMENTATION- excellent results

20
Q

Would nerve root exploration be done in such a setting?

A

Controversial USUALLY LIMITED TO children with CLEAR CUT RADICULAR PAIN or significant WEAKNESS

21
Q

Would the spondylolithesis be reduced?

A

maybe ? It is ssociated with 20-30% incidence of L5 root injuries- normally transient but it is to be used cautiously

22
Q

what does a in situ fusion leave the pt with ?

A

A high grade slip, lumbosacral kyphosis with severe compensatory hyperlordosis above the fusion -> longterm problems so reduction in high grades is gaining widespread acceptance.

23
Q

How would a slip be reduced ?

A

Close neurological monitoring ia neede during the procedure and for several days after

24
Q

What is the tx of grade V- spondyloptosis?

A

Vertebrectomy and fusion

25
Q

Who normally suffers form degenerative spondylolithesis?

A

African americans diabetes Women >40 yrs people with transitional L5 vertebra and sagittally orientated facet joints

26
Q

Which vertebra level is most effected?

A

L4-5

27
Q

How do pt normally present with degenerative spondylolithesis?

A

L5 RADICULOPATHY- from central and lateral recess stenosis causing root compression in the lateral recess between the hypertrophic and subluxed inferior facet of L4 and the postsup body of L5

28
Q

What is the tx for a pt with degenerative spondylolithesis?

A

NON OP- same as stenosis surgery= DECOMPRESSION OF THE NERVE ROOTS NAD STABILISATION BY POSTLATERAL FUSION

29
Q

What are the outcomes for a pt with degenerative spondylolithesis?

A

SPORT trial= 4 yr follow up there was SIGNIFICANT IMPROVEMENT IN PRIMARY OUTCOME MEASURES FOR OPERATIVE CF NON OPERATIVE

30
Q

What do adult pt with ISTHMIC spondylolithesis present with?

A

lower back pain L5 radicular pain

31
Q

What is the aetiology of adult ISTHMIC spondylolithesis?

A

*FORAMINAL STENOSIS- BY a)hypertrophy of fibrous repair at the site of the pars defect b) ucinate spur formation on post L5 body c) bulging of L5/s1 disc * LATERAL RECESS STENOSIS- FACET ARTHROSIS and hypertrophy of ligamentum flavum * CENTRAL STENOSIS- rare ASSOCIATED WITH INCREASE PELVIC INCIDENCE 70-80 DEGREES (n 50-55- a line drawn from centre of s1 endplate to centre of femoral head, a second line is drawn perpendicular to line drawn along s1 endplate, insecting the point at centre of s1 endplate. angle between 2 lines= PI) as pelvic incidence increases-> SACRAL SLOPE INCREASES-> greater LUMBAR LORDOSIS *PARS DEFECT

32
Q

What vertebral level is most commonly effected in isthmic spondylolithesis?

A

L5/S1 -> compression of existing L5 nerve root by a)hypertrophy of fibrous repair at the site of the pars defect b) ucinate spur formation on post L5 body c) bulging of L5/s1 disc

33
Q

What is the tx of isthmic spondylolithesis?

A

NON OP- hamstring stretching, core strengthening, lumbar flexion exercises NSAIDS OP-FORAMINAL DECOMPRESSION INSITU L4, L5-S1 POSTLAT FUSION

34
Q

What is isthmic spondylolithesis caused by ?

A

A defect in the PARS INTERARTICULARIS usually acquired from MICROTRAUMA

Spine FRCS (20 decks)

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