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Spondylolisthesis

[DEFINITION]

  • A condition effecting the vertebrae in which a sliding of one vertebrae upon the adjacent vertebrae occurs. This mechanical defect of the spine most commonly occurs in the lumbar spine or low back. The superior (vertebrae above) vertebrae will slide "anteriorly" (forward) or "posteriorly" (backward).

  • A defect in a structure known as the "pars interarticularis" allows for this sliding effect. The spine can be visualized as a set of stacked units, much like building blocks. The body of the vertebrae is the bulky and most stable part of these units with each vertebral body being seperated by a intervertebral disc, or "shock absorber".

  • The "pars interarticularis" for each vertebrae are part of the anatomy that allows each stacked unit to articulate or move upon each other. It is located in what is visualized as the "spiney" projections on xrays taken from a "side" or lateral view. A break or fracture in the pars interarticularis that is significant will result in the sliding of the effected vertebrae out of its stable position.

  • It most commonly occurs at the L4-L5 or L5-S1 levels of the lumbar spine or "low back". A defect in the pars that does not result in a sliding of the vertebrae, as described, is known as "spondylolysis". The fracture in both spondylolysis and spndylolisthesis may be a result of repeated stresses that fatigue the pars to the point of fracture.

  • These stresses include activities causing hyperextension of the spine ie backward bending movements. Spondylolysis, or a defect without a break in the pars, is most common is children and adolescents participating in gymnastics, diving, high impact team sports, and weightlifting. This may remain asymptomatic or cause low back pain.

  • In spondylolithesis, the pars is fractured and a degree of sliding of the vertebrae has occured. It is clinically suspected and verified by X-ray studies. Symptoms may include low back pain and leg pain. The grade or degree of displacement will determine the treatment.

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