Blog Post: Spondylolisthesis
(Part 1) 8-6-2021
The last 6 posts have been discussing spondylolysis or pars
fractures, which is crack in the posterior part of the spine which causes low
back pain.
If the vertebra slides forward (see below diagram), it is no
longer spondylolysis, it is now called “spondylolisthesis” which means
“vertebral slippage”.
There are 6 types of
spondylolistheses, using the Wiltse classification (below).
In pediatric/adolescent patients there are two main kinds of
spondylolisthesis:
1.
Isthmic. There is a crack in the pars region,
which allows the vertebra to slip forward.
2.
Dysplastic.
In this type the posterior elements do not have a crack in them. Rather the bone never developed normally and
allows the vertebra to slip forward.
DYSPLASTIC
Most of the spondylolisthesis I have taken care of have been
the isthmic type.
Treatment of Spondylolisthesis
The first step in determining treatment is to establish the
grade of the spondylolisthesis. We use
the Meyerding classification, which goes from 1-5.
The more the vertebra slips the higher the grade (see above
diagram):
If the vertebra slips 1-25%, it is a Grade 1 slip
If the vertebra slips 26-50%, it is a Grade 2 slip.
If the vertebra slips 51-75%, it is a Grade 3 slip
If the vertebra slips 76-100%, it is a Grade 4 slip
If the vertebra slip >100%, it is a Grade 5 slip
The Meyerding classification is used to determine the first
step:
If the
spondylolisthesis is a Grade 1 or 2, we call it “Low Grade” and the primary
treatment is nonsurgical.
If the
spondylolisthesis is a Grade 3, 4 or 5, we call it “High Grade” and the primary
treatment is surgical.
The next blog post we will discuss Low Grade
Spondylolisthesis and treatment.
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