Spine Archive: Spondylolisthesis

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Reasons for Spinal Fusions

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In a spinal fusion, vertebral bones are fused or “welded” together resulting in a single bone in the fused area. This process is generally most beneficial for patients with pain in the lower back. This pain can be associated with degenerative disc disease where deterioration of the spinal discs has left very little space for the vertebra to move correctly or spine “slippage” like spondylolisthesis where the vertebrae has become misaligned.

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Common Surgical Procedures in Children

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Diagnostic findings are important to determine the severity of cases in children. Once a full diagnosis has been completed the physician will determine the discourse of treatment. Common spine surgeries in children include treatments for scoliosis, kyphosis (forward hunching of the back), lordosis (swayback), and spondylolisthesis (vertebral slippage).

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Spondylolisthesis Severity

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The lower back is often a point of pain and discomfort relating to spinal issues. This is because the lower back supports a large amount of weight and is also responsible for high levels of motion too. The wear on the lower back can cause vertebra to contact the nerve roots or spinal cord. The severity at which the bone or vertebra slips forward onto the bone below is measured by the Meyerding grading classification. This grading system includes grades I through IV with IV being the most severe level of slippage.

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Isthmic Spondylolisthesis

Isthmic Spondylolisthesis, while normally affecting children, can manifest well into maturity. To learn more about this, search Dr. Anthony Leone’s Knowledge Center.

When one vertebral body shifts onto the one below it, this causes tiny fractures in the bone connecting the two joints. This fracture is caused by stress to the bone fragment. This fracture is most common in young patients and symptoms generally do not manifest until maturity. When the vertebral body shifts (as opposed to fractures), this is known as spondylolisthesis. Surprisingly enough, this phenomenon rarely leads to associated back pain in the patient.

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Degenerative Lumbar Disorders, Western NY

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Surgical decompression may be necessary in those patients unresponsive to conservative treatment (which may include epidural steroid injections). Goals of surgery include central decompression, foraminotomy, and partial facetectomy for lateral recess stenosis. Fusion is recommended for those patients with spondylolisthesis.¹

¹Garfin MD, Steven. Orthopaedic Knowledge Update : Spine. Rosemont: American Academy of Orthopaedic Surgeons, 1997.

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Isthmic Spondylolisthesis, Western NY

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Isthmic spondylolisthesis is caused by fracture or elongation of the pars interarticularis. Although it can manifest itself in childhood or adolescence, it is not congenital; fetal autopsy studies have failed to show its existence. Patients with a history of participation in gymnastics or in football as interior lineman have higher incidence because of the frequent hyperextension of the spine that those sports require.¹

¹Garfin MD, Steven. Orthopaedic Knowledge Update : Spine. Rosemont: American Academy of Orthopaedic Surgeons, 1997.

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Surgical Treatment of Spondylolisthesis, WNY

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Failure of conservative management (persistence of pain, progression of neurologic symptoms, or progression of slippage) is an indication for surgical treatment. Numerous approaches to surgical reconstruction have been used. These approaches include anterior interbody fusion, posterolateral fusion with and without instrumentation, anterior-posterior procedures, and posterior interbody procedures.¹

¹R. Vaccaro MD, Alexander. Orthopaedic Knowledge Update. Rosemont: American Academy of Orthopaedic Surgeons, 2005.

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Thoracic and Lumbar Spine Posture, Buffalo, New York

Correct posture is important for general spine health and care. You can read more about spine care in Dr. Leone’s Knowledge Center.

The surgeon will examine gait, posture, and motion as the patient enters the room and moves from chair to examining table and back. A waddling gait may be seen in spondylolisthesis as a result of hamstring tightness associated with flexed hips and knees and a flexed pelvis. Patients with quadriceps weakness hyper-extend the knee when walking to lock the joint and prevent giving away.¹

¹Garfin MD, Steven. Orthopaedic Knowledge Update : Spine. Rosemont: American Academy of Orthopaedic Surgeons, 1997.

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Developmental Spondylolisthesis

Developmental spondylolisthesis was formerly referred to as congenital spondylolisthesis. current thought is that the defects and slip are not present at birth but develop over time. Unlike acquired isthmic spondylolisthesis, the pars fractures are thought to develop as a result of the slippage rather than causing the slip. The dysplastic nature of this type of spondylolisthesis often leads to the development of high-grade slips. Developmental spondylolisthesis is the most common type of slip seen in children.

¹R. Vaccaro MD, Alexander. Orthopaedic Knowledge Update. Rosemont: American Academy of Orthopaedic Surgeons, 2005.

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Surgical Treatment of Degenerative Spondylolisthesis

The main goals of surgery are pain reduction, restoration of function, and preservation of neurologic function. The most common indication for surgery is persistent incapacitating claudication and radicular leg pain, which significantly compromises function, and the failure of 6 to 12 weeks of nonsurgical therapy to relieve symptoms.

¹R. Vaccaro MD, Alexander. Orthopaedic Knowledge Update. Rosemont: American Academy of Orthopaedic Surgeons, 2005.