Pathological Spondylolisthesis

Spondolylolithesis is a back disorder that occurs when a spinal disc vertebrae slips forward in relation to the vertebrae below. The forward slippage may be caused by a bone defect of the spine, particularly in the pars interarticularis called the pars defect.

Other causes of this syndrome would be due to malformation of the lumbosacral junction (the small of the back and the back portion of the pelvis) with small, incompetent facet joints, which could be congenital (inborn) referred to as Dysplastic Spondolylolithesis or might occur during adolescence due to a fracture or injury to one of the bones of the spine from any sports related activities such as weight lifting, running, swimming or football resulting to a person having Isthmic Spondolylolithesis .

However, a pars defect may be present without the slippage, which is called a Spondylolisis; most likely the precursor of the forward slippage leading to Spondolylolithesis.

There are five major types of Spondolylolithesis as categorized by the Wiltse classification system: Dysplatic or Congenital, Isthmic, Denegrative, Traumatic, and Pathological. The proper diagnosis and identification of the type or category of Spondolylolithesis is important to understand as well as the severity of the slippage which is divided into 5 grades before the appropriate treatment for the condition can be advised.

The Meyerding grading system is commonly used to classify the severity of the slippage. Grade 1 is 0-25%, Grade 2 is 25-50%, Grade 3 is 50-75%, Grade 4 is 75-100%, and Grade 5 is over 100% when the vertebra completely dislocates from the supporting vertebra.

Other causes of Spondolylolithesis could be due to aging, the general wear and tear of the bones, tissues, muscles and ligaments of the spine referred to as Degenerative Spondolylolithesis, or after a major accident or trauma to the back resulting in a condition called Traumatic Spondolylolithesis, and/or some underlying diseases such as arthritis, osteoporosis, tumor or cancer of the spine.

The last type of Spondolylolithesis, which is also the rarest, is called the Pathological Spondolylolithesis. This type of Spondolylolithesis occurs due to damage to the posterior elements from metastases (cancer cells that spread to other parts of the body and cause tumors) or metabolic bone diseases. This type has been reported in cases of Paget’s diseases of bone (named after Sir James Paget, a British surgeon who described a chronic disorder that typically results in enlarged and deformed bones), tuberculosis (a deadly infectious disease that usually attacks the lungs but can spread to other parts of the body), giant cell tumors, and tumor metastases. Furthermore, Paget’s diseases of the bones can cause bones to weaken, resulting in pain, arthritis, deformities and fractures,

Treatment of Spondolylolithesis may vary widely depending on the type, severity and symptoms of the condition. Symptoms could range from a patient experiencing no pain, to mild or acute back, or leg pain, muscle spasms, tightening of the hamstrings, and or an abnormal gait or limp. Conservative treatment of Spondolylolithesis consists of activity modification accompanied with bed rest, pharmacological intervention by recommending anti-inflammatory or pain relieving medicines, physical therapy consultation and a chiropractic treatment. If the symptoms still persists after following the conservative treatment and mostly for severe and rare cases of Spondolylolithesis, surgical treatment may be the last option. Spinal surgery such as posterolateral fusion or spinal fusion (fusion in-situ) to directly repair the pars defect or for a slippage greater than 50% of the width of the adjacent vertebral body, and fusion with implants may be required to stop further slippage and provide relief from the symptoms. In some cases, fusion with decompression also called a laminectomy may be suggested.

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