![]() ![]() Prevalence varies with ethnicity: up to 54% Inuit, 6% to 11% white, and 2% African American.Asymptomatic spondylolysis and spondylolisthesis are estimated to occur in 5-10% of the population.14 Epidemiology including risk factors and primary prevention 1 3Ī newer classification system proposed in 2009 by the Spinal Deformity Study Group proposed six types in this classification system, which combines the severity as assessed by the Meyerding grading and combines this with an assessment of underlying radiographic spinal alignment, including global sagittal balance and sacro-pelvic alignment, which may be useful for prognostication. 11,1 2 Children with dysplastic spondylolisthesis are more likely to have progression of spondylolisthesis (32%) than with isthmic type (4%). It additionally divides developmental spondylolisthesis into low-dysplastic and high-dysplastic. In 1982 Marchetti and Bartolozzi introduced another classification system which differentiates between dysplastic causes and acquired causes. This is a descriptive classification of etiologies but does not help define severity or prognosis of the disease. The most common classification of etiological for spondylolisthesis was described by Wiltse et al in 1976. These radiographic findings can be asymptomatic however they are typically thought to cause low back or buttock pain worse with activity. 8 Changes at the pars interarticularis occur on a spectrum, starting with bone stress reactions of the pars interarticularis, progressing to fracture of the pars (spondylolysis) and with bilateral defects can progress to slippage of the vertebral body (spondylolisthesis).Īll three types of bony changes can be found in pediatric and adolescent patients on radiological imaging. Spondylolysis typically occurs in children during periods of active growth or in adolescents with high activity, especially extension-based activities which load the pars interarticularis. 6 Repeated mechanical stress 7 on the lumbar spine is thought to cause a stress response in the pars growth plate, or once this is ossified, a fatigue fracture of the pars interarticularis. Biomechanical stress through the lumbosacral spine with walking and upright posture may contribute to the development of spondylolysis because the disease has not been described in newborns or non-ambulatory children. Genetic and congenital factors combined with biomechanical stress play major roles. The etiology of pediatric spondylolysis is multifactorial. In pediatric patients, dysplastic causes and isthmic defects are the predominant causes of spondylolisthesis. Spondylolisthesis due to bilateral intervertebral pars fracture is also called isthmic spondylolisthesis or spondylolytic spondylolisthesis. This article focuses on pediatric and adolescent spondylolysis and spondylolisthesis. Spondylolisthesis can occur due to a variety of etiologies. Grade V: greater than 100% (also termed spondyloptosis).Five grades are included in the Meyerding classification system: The extent of slipping is considered a major prognostic factor. 5 This quantifies the degree of slippage of one vertebral body on another on a standing neutral lateral radiograph of the lumbar spine. Meyerding described the first grading of spondylolisthesis in 1932. Spondylolisthesis of L5 over the sacrum was first described by Herbinaux in 1782 3, but Kilian was the first to use the term spondylolisthesis in 1854 4. This is known as spondylolisthesis and refers to forward translation of one vertebral segment over the one beneath it. With spondylolysis, slippage of one vertebra on another may occur. 1 Unilateral pars defects do not typically progress to spondylolisthesis. Spondylolysis may be unilateral or bilateral and occurs almost exclusively in the lumbar spine with L5 level being most often. Spondylolysis refers to a defect or fracture of the vertebral pars interarticularis. ![]() The terms spondylolysis and spondylolisthesis are derived from the Greek roots “spondylos” meaning vertebrae, “lysis” meaning loosening, and “olisthesis” meaning slippage or dislocation. ![]()
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