You are here

Spondylolysis, Spondylolisthesis M43.00 738.4

 

synonyms:

Spondylolysis ICD-10

Spondylolysis ICD-9

  • 738.4 (acquired spondylolisthesis or spondylolysis)

Spondylolysis Etiology / Epidemiology / Natural History

  • Spondylolysis = disruption of the pars interarticularis.
  • Generally from cyclic loading of the inferior articualr facet onto the inferior lamina and pars interarticularis. May be genetic risk factors.
  • Spondylolisthesis = anterior vertebral tanslation in relation to the caudal vertebra.
  • Asymptomatic incidence: spondylolysis = 6%; spondylolisthesis = 3% (Belfi LM, Spine 2006;31:E907).
  • Associated with football (lineman), gymnasts, ballet, figure skating, wrestlers, divers.
  • Etiology: dysplastic, congenital, isthmic, degnerative, traumatic, patholigc.
  • Risk factors: increasing age, obesity, lordotic angle, pelvic inclination (Sonne-Holm S, Eur Spine J 2007;16:821).

Spondylolysis Anatomy

  • L5-S1 slip affects L5 nerve roots.

Spondylolysis Clinical Evaluation

  • Low back pain aggravated by spine hyperextension. May have sciatic/radicular symptoms.
  • Pain reproduced with back hyperextended while standing and performing a single leg hyperextension on the ipsilateral side of the lesion.
  • Often have hip flexor and hamstring tightness.
  • Crouched gait.

Spondylolysis Xray / Diagnositc Tests

  • A/P and Lateral views. Oblique views(30° ). Consider flexion/extension views. Xray findings (pars defect, vertebral slippage) do not correlate with clinical symptoms (Fredrickson BE, JBJS 1984;66A:699).
  • SPECT(single photon emission computerized tomography) is most sensitive in detecting early spondylolysis.
  • CT (3-mm reverse gantry): best defines lesion.
  • MRI: reverse angle oblique axial T1 images and dual echo steady state images best demonstrate lesion. (Udeshi UL, Clin Radiol 1999;54:615).

Spondylolysis Classification / Treatment

  • Meyerding Grading
    -Grade 1:0-15%
    -Grade II; 26-50%
    -Grade III; 51-75%
    -Grade IV:76-100%
    -Grade V: >100% (spondyloptosis)
  • Lumbar corsets or rigid thoracolumbar braces. PT with abdominal strengthening, psoas and hamstring stretching. May consider electromagnetic stimulation for nonunions.
  • Surgery: indicated for intractable pain with ADLs, spondylolisthesis >50%, progressive slippage, neurolic deficit. Surgical options include instrumented or noninstrumented posterolateral fusion, interbody fusion. Slip reduction has not demonstrated long-term clinical benefits verses insitu fusion. Consider vertebral resection for Grade V spondylolisthesis (Gaines RW, Spine 2005;30:S66).
  • Surgical treatment for degenerative spondylolisthesis and associated spinal stenosis has shown improved outcomes compared to non-op treatment at 2 and 4 yrs post-op (Weinstein J, JBJS 2009;91:1295).

Spondylolysis Associated Injuries / Differential Diagnosis

  • Spina bifida occulta
  • Tumor (malignancy/primary)
  • Infection
  • Facet arthrosis

Spondylolysis Complications

Spondylolysis Follow-up Care

  • May return to sports when painfree with full ROM and strength.
  • @12% of patients with bilateral pars defects and minor slippage will shown progression.

Spondylolysis Review References

  • Staendaert CJ, Br J Sports Med 2000;34:415

Disclaimer

The information on this website is intended for orthopaedic surgeons.  It is not intended for the general public. The information on this website may not be complete or accurate.  The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care".  While the information on this site is about health care issues and sports medicine, it is not medical advice. People seeking specific medical advice or assistance should contact a board certified physician.  See Site Terms / Full Disclaimer