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DIAGNOSTIC IMAGING II > Spondylolisthesis > Flashcards

Spondylolisthesis Flashcards

1
Q

What is a Spondylolisthesis?

A

Generic term to indicate slippage of a vertebra

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2
Q

What do you use in a suspected Spondylolisthesis to compare the involved segment to the level below it?

A

Posterior Vertebral Body Line (George’s Line)

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3
Q

What are the 4 things that should be described for every spondylolisthesis?

A
  • Level
  • Direction
  • Degree
  • Due to
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4
Q

Spondylolisthesis: Report the ___ rather than the ___

A

level; motion segment

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5
Q

Describe an Anterolisthesis

A

Anterior slippage

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6
Q

Describe a Retrolisthesis

A

Posterior slippage

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7
Q

Describe a Laterolisthesis

A

Lateral slippage to the right or left

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8
Q

What does the degree of a Spondylolisthesis reprsent?

A

Helps quantify the amount of slippage in millimeters or centimeters

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9
Q

What type of Spondylolisthesis has a Grading scale?

A

Anterolisthesis (Myerding classification)

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10
Q

What types of Spondylolisthesis cannot be applied to the Myerding classification?

A

Retrolisthesis
Laterolisthesis

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11
Q

What % is Myerding classification Grade 1?

A

0-25% anterior translation

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12
Q

What % is Myerding classification Grade 2?

A

25-50% anterior translation

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13
Q

What % is Myerding classification Grade 3?

A

50-75% anterior translation

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14
Q

What % is Myerding classification Grade 4?

A

75-100% anterior translation

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15
Q

What % is Myerding classification Grade 5?

A

> 100% anterior translation

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16
Q

What should you remember when looking at the etiology of Spondylolisthesis?

A

Always look at the posterior elements

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17
Q

What are the six components of Wiltse classification?

A
  1. Dysplastic
  2. Isthmic (Pars interarticularis involved)
  3. Degenerative
  4. Traumatic (Region other than pars involved)
  5. Pathologic
  6. Iatrogenic
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18
Q

What are the two most common components of Wiltse classification?

A
  1. Isthmic
  2. Degenerative
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19
Q

Describe a Dysplastic Spondylolisthesis

A

Congenital or developmental anomaly of the posterior arch

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20
Q

Dysplastic Spondylolisthesis: More common in cervical or lumbar spine?

A

Cervical spine

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21
Q

Dysplastic Spondylolisthesis: What might the cervical region show?

A

Absent articular pillars

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22
Q

Dysplastic Spondylolisthesis: What will the lumbar region show?

A

Elongated or Malformed posterior element

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23
Q

Dysplastic Spondylolisthesis: Common or Uncommon etiology?

A

Uncommon etiology

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24
Q

Describe an Isthmic Spondylolisthesis

A

Involves the pars interarticularis in the lumbar spine

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25
Q

What is the MC location for an an Isthmic Spondylolisthesis?

A

LS (90%)
- L4 (4%)
- L1, L2, L3 (3%)

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26
Q

Describe an Isthmic Type 2A Spondylolisthesis

A

Fatigue fracture of the pars AKA Spondylolytic
- common in gymnast and mechanic

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27
Q

What is the MC type of Isthmic Spondylolisthesis?

A

Type 2A Spondylolytic

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28
Q

Describe an Isthmic Type 2B Spondylolisthesis

A

Elongation but intact pars
- microtrauma
- remodeling

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29
Q

Describe an Isthmic Type 2C Spondylolisthesis

A

Acute traumatic pars fracture
- MVA
- Hit in sports

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30
Q

What is the most common spondylolisthesis in people under the age of 50?

A

Isthmic 2A Spondylolytic

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31
Q

What causes a Isthmic 2A Spondylolisthesis?

A

Due to a fatigue fracture of the pars that heals non-union
- Not a congenital anomaly
- Can have spondylolysis without spondylolisthesis

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32
Q

How do you properly describe an Isthmic 2A Spondylolisthesis?

A

Pars defect is used over pars fracture (fracture implies acute injury)

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33
Q

Why is there a difference in incident rates of Isthmic 2A Spondylolisthesis between certain populations?

A

Differences in incidence believed to be due to the thickness of the pars interarticularis

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34
Q

Which patient histories should make you search for a pars defect (3)?

A
  1. Adolescent patient (10-15 YOA)
  2. Repetitive hyperextension loading
  3. Fatigue fracture of the pars interarticularis
    - Continuation of activity
    - Resulting in non-union healing
35
Q

Which populations are at an increased risk for Isthmic 2A Spondylolisthesis?

A
  • Gymnasts
  • High divers
  • Cheerleaders
  • Weightlifters
  • Pole-vaulters
36
Q

What imaging should you order is an active pars fracture is suspected?

A
  1. Radiograph
  2. MRI
37
Q

What radiographic series should you order if an active pars fracture is suspected?

A

-AP, Lateral, and Oblique views
- For L5, Ferguson (tilt-up) view

38
Q

What kind of MRI should you order if an active pars fracture is suspected?

A

MRI w/o contrast to assess for bone marrow edema in the area of the defect
- can signify acute fatigue fracture or instability

39
Q

How do you treat a patient with an active pars defect?

A
  • Get the patients off activity
  • Boston brace (typically done via an orthopedist)
40
Q

What is the radiographic approach for an Isthmic 2A Spondylolisthesis?

A
  1. Check the AP and lateral first
    - if you see the defects then no reason to do additional views
  2. If still unsure, at L5 use Ferguson view
    - other levels and AP should show it however the obliques may be more rewarding
41
Q

What part of the Scotty dog is the pars interarticularis?

A

Pars is the neck of the dog

42
Q

How will patients present with an Isthmic 2A Spondylolisthesis?

A

The active 2A will present with back pain

43
Q

What should you do if you can diagnose an active Isthmic 2A pars defect?

A
  • Remove from activity
  • Utilize a brace to allow fatigue fracture to heal (may take ~6-8 weeks to heal)
44
Q

What happens once an Isthmic 2A Spondylolisthesis heals non-union?

A

Majority are asymptomatic

45
Q

Isthmic 2A Spondylolisthesis: Strong or Poor correlation between severity of slippage and symptoms?

A

Poor correlation

46
Q

What shouldn’t patients with an asymptomatic spondylolisthesis be prevented from doing?

A

Participating in sports or other physical activity

47
Q

What are the physical exam findings of an Isthmic Type 2A Spondylolisthesis (3)?

A
  1. Accentuated lordosis
  2. Stork test (if active)
  3. Spinous process with palpable defect
    - Isthmic: SP of above segment moves anteriorly
    - Degenerative: SP of affected segment moves anteriorly
48
Q

What does an Isthmic 2A type Spondylolisthesis look like in adults?

A
  1. Major concern for instability
  2. Believed to an incidental finding
  3. Would result in widening or opening of the spinal canal
    - may narrow the IVF over a long period of time
49
Q

What factors increase the risk of progression for an Isthmic 2A Type Spondylolisthesis?

A
  • 2-3% will show progression
  • Occurs between 5-15 YOA
  • Most likely within the first 2 years after fracture
  • <18 YOA
50
Q

What factors reduce the likelihood of progression of Isthmic 2A Type Spondylolisthesis?

A
  • Male
  • Low grade slippage
  • Buttressing (laying down more bone)
  • Older than 18 YOAs
51
Q

What are common indicators of progression or instability in Isthmic 2A Type Spondylolisthesis?

A
  • Poor response to conservative management
  • Serial progression documented from prior imaging
  • Higher grade slippage is more likely (Grade 3+)
  • Rounding of the sacral base (doming)
  • Trapezoidal L5 vertebral body shape (posterior appears shorter than the anterior height)
52
Q

What is an Isthmic 2B Type Spondylolisthesis?

A

A cycle of fatigue fracture, healing, then another fatigue fracture

53
Q

What does an Isthmic 2B Type Spondylolisthesis lead to?

A

Elongation/Remodeling

54
Q

Isthmic 2C: Rare or Common?

A

Rare

55
Q

What is the MOI of an Isthmic 2C Type Spondylolisthesis?

A

Secondary to acute hyperextension
- Being clipped in football
- Often see other injuries (compression fractures)

56
Q

Isthmic 2C Type Spondylolisthesis: What can be hard to determine on a radiograph?

A

Chronicity

57
Q

Isthmic 2C Type Spondylolisthesis: What is required for characterization?

A

MR or CT imaging

58
Q

True or False: Unilateral Spondylolysis is less common than a bilateral.

A

True

59
Q

What are some characteristics of a Unilateral Spondylolysis

A
  • Frequently overlooked on imaging
  • No spondylolisthesis would be visualized
60
Q

What might a Unilateral spondylolysis progress to?

A

May heal or progress into a bilateral defect

61
Q

What do we see radiographically with a Unilateral Spondylolysis?

A

Wilkinson Syndrome –> Dense unilateral sclerotic pedicle

62
Q

What is a DDX of a Unilateral Spondylolysis?

A

Osteoid Osteoma

63
Q

What is the most common type of Spondylolisthesis in patients older than 50 YOA?

A

Degenerative

64
Q

What does the slippage seen in Degenerative Spondylolisthesis result from?

A

Facet or disc degeneration
- facet orientation changes with advanced facet degeneration

65
Q

Degenerative Spondylolisthesis: Neural arch intact or broken?

A

Neural arch will be intact

66
Q

What is the most common level for a Degenerative Spondylolisthesis?

A

MC level is L4

67
Q

What is a Degenerative Spondylolisthesis associated with?

A
  • Central canal stenosis
  • Neurogenic claudication
68
Q

True or False: Degenerative Spondylolisthesis typically won’t be greater than a Grade 1

A

True

69
Q

What is a Traumatic Spondylolisthesis?

A

Acute fracture of the posterior arch not involving the pars interarticularis

70
Q

Define a Hangman fracture

A

Fracture of the C2 pedicle region

71
Q

What do we see radiographically with a Traumatic Spondylolisthesis?

A

Facet dislocation (uni or bilateral)

72
Q

What are 4 diseases that result in weakening of the pars interarticularis, increasing its susceptibility to fracture?

A
  1. Osteoporosis
  2. Metastasis
  3. Paget
  4. Osteopetrosis
73
Q

True or False: Iatrogenic Spondylolisthesis is apart of original Wiltse Classificaiton.

A

False

74
Q

Where is an Iatrogenic Spondylolisthesis commonly seen?

A

Adjacent segments to a surgical fusion

75
Q

What is your first step when presented with an Iatrogenic Spondylolisthesis?

A

Obtain flexion and extension views

76
Q

How do you test the instability of a Spondylolisthesis?

A

Functional radiography
Compression-traction
Flexion-Extension

77
Q

What is the Yochum value for lumbar instability?

A

4mm of translation
- Excessive angular motion (>11 degrees)

78
Q

How do you manage a stable (inactive) spondylolisthesis?

A
  • Chiropractic treatment
  • Biomechanical evaluation of the pelvis and lower extremity
79
Q

How do you manage an unstable (active) spondylolisthesis?

A
  • Boston antilordotic brace (acute)
  • Surgical arthrodesis (chronic)
80
Q

What are 3 etiologies of a Cervical Spondylolisthesis?

A
  • Congenital
  • Traumatic (Facet dislocations, Hangman Fx.)
  • Degenerative
81
Q

What level is a Cervical (Congenital/dysplastic) Spondylolisthesis most common at?

A

C6

82
Q

What radiographic features do we see with a Cervical (Congenital/dysplastic) Spondylolisthesis?

A
  • Anterolisthesis usually seen
  • Spina bifida occulta
  • Hypoplastic pedicles and articular processes
83
Q

What do we see radiographically with a Cervical (Degenerative) Spondylolisthesis?

A
  • Can see anterolisthesis or retrolisthesis
  • Usually involves the mid-cervical region

DIAGNOSTIC IMAGING II (9 decks)

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