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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