The Different Types of Spondylolisthesis
This
classification system has 5 different kinds of spondy’s
1.
Isthmic
The most
common type of spondylolisthesis especially amongst adolescent athletes,
isthmic spondy’s can be caused by either an acute fracture or stress fracture
(fatigue in the bone resulting in a fracture over time).
2. Degenerative
Degenerative
spondy’s are commonly caused by instability between vertebrae which can cause
degenerative changes to the pars interarticularis which can eventually lead to
a fracture and slippage.
Sometimes
degenerative spondy’s do not involve a break, but just a slip of one vertebrae
over another.
Degenerative
spondy’s are most prevalent in individuals over 40 and are more common in women
due to the higher rate of osteoporosis in the female community.
3.
Dysplastic
This type of
spondy is due to a birth defect of the pars interarticularis (a portion of the
vertebrae) that eventually allows for slippage to occur.
When
compared to isthmic spondy’s, dysplastic spondy’s are quite rare.
4.
Traumatic
Traumatic
spondy’s occur as a result of a fracture to structures other than the pars interarticularis.
This type of
spondy is even rarer than the dysplastic.
5.
Pathologic
Pathologic
spondy’s occur as a result of damage from bone disease thus leading to
slippage.
Pathologic
spondy’s are also very rare.
In our
experience, most of the spondy’s we see fall into the category of isthmic with
degenerative being a distant second. The other three classifications are
very rare when compared to isthmic and degenerative.
Severity
Classification by degree of
the slippage, as measured as percentage of the width of the vertebral body:
- Grade
I: 0-25%
- Grade
II: 25- 50%
- Grade
III: 50-75%
- Grade
IV: 75-100%
- Grade V: greater than 100%
Symptoms and findings:
- Low-back
pain
- Pain
radiating down the leg
- Neurological
symptoms (possible evolution towards cauda equine syndrome)
- Atrophy of
the muscles, muscle weakness
- Tense
hamstrings, hamstrings spasms
- Diminished
ROM (spine)
- Disturbances
in coordination and balance
Risk Factors
Known
risk factors include:
§ Sports involving
hyperextension and rotation
§ Genetic
predisposition. You have a 26% chance if a parent has one.
§ Spondylolisthesis:
Females 2-3 times
§
Spondylolysis (no
slip): Males 2-3 times
§ Generalised
hypermobility.
§ Spina bifida
occulta
§ Facet joint
morphology
§ Inuit population
§ Degenerative
spondylolisthesis is more prevalent in pregnant women and black
individuals.
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