Spondylolithesis

1. How is spondylolisthesis classified?
*2. What is the most common cause of spondylolisthesis? What are other causes?
3. What is the presentation of spondylolisthesis?
4. What diagnostic studies are used?
5. What amount of spondylolithesis results in instability?
6. What is the treatment?

Answers:
1. Grade 0 is 0% slippage. Grade 1 is <25%.>100% slippage.
2. Most common is isthmic (age 5-50), which results from a pars fracture (most common at L5-S1) or an elongation. Other causes are congenital, degenerative (facet arthrosis), traumatic, cancer, infection, metabolic disorders, post-surgical.
3. Low back pain, worse with motion, hamstring tightness, step-off on exam. May have radicular symptoms.
4. X-rays, bone scan, CT, MRI. Flex-ex views may show instability.
5. Instability occurs with translation > 3.5mm in the cervical region or >5mm in the thoracic or lumbar region.
6. Conservative care can be used with grade 1, 2, and asymptomatic 3. Rehab involves focus on stabilization exercises in a flexion biased program and hamstring flexibility. Surgical care for higher grades including a bilateral posterolateral fusion w/wo decompression.