ISTHMIC

SPONDYLOLISTHESIS
SUPERVISOR:
DR. JAINAL ARIFIN, M.KES,SP.OT(K)SPINE

ISNA MUSTIKA
C11111203
Definition
Spondylolisthesis :
an anterior or posterior translational
displacement of one vertebra on
another.
occurs in the lumbar spine as a result of

defects in
the bony architecture, trauma, or
degeneration.
Isthmic spondylolisthesis : occur
which involves abnormalities of the pars
intra-articularis
Classification
Wiltse Classification :

A occurs as a result of fatigue failure of the

pars and is evident by a complete defect or
separation of the bone.
B an elongated pars occurs as a result of
repeated microtrauma with subsequent
healing of the bone as the slippage
gradually occurs.
C is an acute pars fracture.
Isthmic
spondylolisthesis
Incidence
4% to 6% in the general population.
more common in males and at the L5-S1 level.
result of degenerative more common
occurring as a
in females older than the age of 40.
According to race
6.4% in white American males,
2.8% in black males,
2.3% in white females,
1.1% in black females.
Eskimos have been shown to have a rate as high
as 50%
Diagnosis

History

Physical
Examination

Imaging
 Most people are
asymptomatic
symptomatic ry
usually present
with back pain,
Histo
leg pain, or a
combination
paresthesia
Diagnosis
 Palpation :
midline tenderness,
a stepof of the spinous
processes
limited fexion of the
lumbar spine
High grade : trunk ion
foreshortening and Examinat
hamstring tightness
Neurologically, may be
Physical
motor weakness or
sensory deficits
hyperlordosis above the
slip and a waddling gait
may be present
Cauda equina syndrome is
rare Diagnosis
 Radiographic
AP and lateral
fexion-extension ng
supine and standing
lateral
Imagi
oblique
CT scans
MRI
SPECT scans
Diagnosis
Treatment Options

nonoperative plan consisting of

medication, physical therapy,and
bracing,

surgical intervention
Conservative Treatment

Nonsteroidal anti-inflammatory drugs

(NSAIDs),

pain management,

physiotherapy.
Surgical Options

direct repair of the pars

decompression
decompression of posterior lateral fusion
with associated pedicular
instrumentation;
decompression and reduction of the
spondylolisthesis with instrumentation
and interbody fusion.
Surgical Repair
Indications
failed a full course of conservative
treatment
Severe back and leg pain,
evidence of radiographic instability,
progression of the spondylolisthesis,
a progression of the neurologic deficit, or
cauda equina symptoms.
Surgical Repair
Contraindications

Relative : expected poor outcome

patients who continue to smoke and
have either disability or compensation
Surgical Goals

stabilization of the affected levels along

Stabilization prevents further slippage of
the vertebra.
prevents further progression of the neural
deficit and allows the present deficit the
best chance to recover.
In the high-grade slips, the cosmetic
problem that results from the posture and
gait abnormalities can be an indication
Complications

related to bone grafting

chronic graft site pain in approximately 5%
of patients;
related to fusions,
pseudarthrosis,
bleeding, and
infection;
Complications
related to instrumentation
loss of fixation,
pedicular fracture,
loosening at the screw-bone interface,
breakage of the implant
Those related to spinal decompression
nerve damage,
tears,
Dural
arachnoiditis,
and postsurgical scarring of the neural
elements.
Diferential Diagnosis

The differential diagnosis should

include :
spondylosis,
disc herniation,
infections such as discitis or osteomyelitis,
and spondyloarthropathy,
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