HighGradeSpondylolisthesis.pptx
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1) Spondylolisthesis is the slippage of one vertebra over another, usually occurring at the L5-S1 level. It can be asymptomatic but sometimes causes back and leg pain. 2) The causes include dysplasia of the pars interarticularis, fractures from repetitive stress, and activities that increase lumbar lordosis. High grade spondylolisthesis affects over 50% of the vertebral body. 3) Sagittal balance and alignment of the pelvis and spine are important factors in determining treatment. Patients with altered sagittal balance or pelvic parameters may be more prone to spondylolisthesis due to increased mechanical stress at L5-S1.
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This review article summarizes research from the Spinal Deformity Study Group on classifying spondylolisthesis based on sagittal spinopelvic alignment. The classification defines 6 types based on grade of slip, pelvic incidence, and spino-pelvic alignment. Research found abnormal pelvic and spinal parameters in spondylolisthesis patients compared to controls. For low grade slips, some have increased pelvic tilt and lordosis ("shear" type) while others have decreased parameters ("nutcracker" type). High grade slips were found to have two alignment subgroups - a "balanced" group standing with high sacral slope and a "retroverted/unbalanced" group with low sacPathophysiology of Spondylolisthesis.pptx
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- Several classification systems are described including the Wiltse, Newman and Macnab classification based on etiology and topography.
- Risk factors for slip progression include developmental spondylolisthesis with lysis, isthmic spondylolisthesis from repetitive loading, and increased pelvic tilt.
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- It can be caused by a defect in the pars interarticularis that allows slippage.
- Treatment options include non-operative measures like bracing or injections, or surgical options like decompression or fusion to correct the slippage and stabilize the spine.
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HighGradeSpondylolisthesis.pptx
- 1. High Grade Spondylolisthesis Dr Tejasvi Agarwal Consultant Spine Surgeon Get Well Spine
- 3. Introduction The term spondylolisthesis is defined as a translation of one vertebra over another in the anterior or posterior direction. Considering that the spondylolisthesis is a slippage of a portion of the column over the adjacent part, we must remember that the column slid also moved the entire trunk, and this may bring clinical consequences.
- 4. Spondylolisthesis and spondylolysis are usually well tolerated by patients, But in some cases the severity of the symptoms and a condition unresponsive to conventional medical treatment have caused the indication for surgical treatment.
- 5. Epidemiology and aetiology The incidence of spondylolysis in the general population is about 6%, with a male: female ratio of 2:1. The incidence of spondylolisthesis in children under 6years is 2.6%, while in adults it is 5.4%. The degenerative spondylolisthesis rarely affects individuals below the age of 40 years, and is four to five times more common in women than in men.
- 6. The dysplastic lesions of the pars interarticularis, fracture or of the elongament and of spina bifida conceal a broad distal spinal canal. Dysplasia in both facets (lower lumbar and upper sacral) is a common finding in spondylolisthesis, especially in those with high grade.
- 7. Dysplasia can occur in either or both facets. The presence of spondylolysis/spondylolisthesis is rare in non- ambulatory patients, Which attaches importance to the orthostatism role and of repeated micro- traumas in the development of spondylolysis.
- 8. Activities that increase lordosis and maintain the column in extension, such as Olympic gymnastics, diving, weight lifting, volleyball, football and, Pathologies such as kyphosis, increase the incidence of fracture of the pars and of spondylolysis and spondylolisthesis.
- 9. Sagittal balance in spondylolisthesis The spondylolistheses are divided into high (slippage >50%) and low (slippage <50%) grade. The classifications used for spondylolisthesis are not useful for surgical treatment indications and, as noted in the last decade. the sagittal balance is the key factor for surgical treatment.
- 10. One explanation for the aetiology of developmental spondylolisthesis, which takes into account the sagittal balance, is that, in the presence of spondylolysis and bone dysplasia, the mechanical stress applied to the lumbo sacral junction is increased because of the altered sacro pelvic morphology, which leads to an abnormal secondary spino-pelvic equilibrium.
- 11. Pelvic Incidence(PI) Defined as the angle between the line connecting the midpoint of upper plateau of S1 and the centre of femoral rotation and the line perpendicular to the upper plateau of S1
- 12. Sacral Slope and Pelvic tilt
- 13. Sagittal Balance and Plumb Line
- 20. Conclusion: The proposed classification emphasizes that subjects with L5-S1 spondylolisthesis are a heterogeneous group with various adaptations of their posture, And that clinicians need to keep this fact in mind for evaluation and treatment.
- 21. Thankyou