Spondylolisthesis 01


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:
  1. Grade I: 0-25%
  2. Grade II: 25- 50%
  3. Grade III: 50-75%
  4. Grade IV: 75-100%
  5. Grade V: greater than 100%

Symptoms and findings:
  1. Low-back pain
  2. Pain radiating down the leg
  3. Neurological symptoms (possible evolution towards cauda equine syndrome)
  4. Atrophy of the muscles, muscle weakness
  5. Tense hamstrings, hamstrings spasms
  6. Diminished ROM (spine)
  7. 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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