Spondylolisthesis Wiltse Classification n Type IDysplastic congenital malformation

Spondylolisthesis

Wiltse Classification n Type I—Dysplastic (congenital malformation of sacrum or neural arch) n n n Trapezoidal L 5, rounded sacrum, highgrade slip astd with progression, Boxall slip angle >55 14 -21% Astd with spina bifida

Wiltse Classification n Type IIA—Isthmic, lytic (fatigue fracture) Type IIB—Isthmic, elongation of pars Type IIC—Isthmic, acute fracture of pars

Wiltse Classification n Type IIA—Isthmic, lytic (fatigue fracture) Type IIB—Isthmic, elongation of pars Type IIC—Isthmic, acute fracture of pars n n n n Eskimos 30%, Japanese 40% 15 -70% in ist deg relatives Never before walking age 4. 4% 6% in adulthood Fast bowlers, L 5 Commonest (50%) 25% chance of slip progression

Wiltse Classification n Type III—Degenerative (facet joint failure) n n Commonest in >50 yr Female > male 25 times more common if facet angle > 45 deg (Love TW, JBJS Br 1999) L 4 -L 5

Wiltse Classification n Type IV—Acute fracture of posterior elements other than the pars

Wiltse Classification n Type V—Pars elongation due to pathology (tumour, multiple myeloma, OI) n Type VI - Iatrogenic

Meyerding Grading

Marchetti and Bartolozzi

PI and Spondylolisthesis

PI and Spondylolisthesis

Lysis

X-ray

CT-scan

MRI

SPECT-CT n SPECT: highest sensitivity for bone activity CT: highest anatomical specificity n Neg CT + Pos SPECT n n Stress response, Pre-lysis Good prognosis for healing and bony union Pos CT + Neg SPECT n Non-union chronic lesion

Treatment Activity modification n (Bracing) n Physiotherapy n n n Lower abdominal Hamstring stretch Spinal flexion Pars blocks

Pars repair

Surgery Gill procedure n Fusion n n Postero-lateral n Uninstrumented / instrumented

Inter-body fusions Better reduction n Restore foraminal height n Bigger surface area for fusion n Graft is under compression n

ALIF v TLIF v PLIF v DLIF v XLIF v Axia. LIF v OLIF