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Surgery for Spondylolysis and Spondylolisthesis
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Posted on: 11/30/1999
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Surgeons at Mayo Clinic in Minnesota and St. Christopher's Hospital for Children in Philadelphia team up together to offer a review of the surgical treatment of spondylolysis and spondylolisthesis in children. These two conditions affect the lumbar spine. Each one is either repaired or fused depending on the status of the condition.
In spondylolysis there is a small fracture in the pars interarticularis of the vertebra referred to as a pars defect. At this point the bone is still intact. The child may or may not have any painful symptoms. Treatment is usually with activity modification, physical therapy, and bracing.
If the bone separates at the fracture site, it's called spondylolisthesis. A small forward movement of the bone is referred to as a "slip" or low-grade spondylolisthesis. Children aren't as likely to respond well to conservative (nonoperative) treatment for this condition. Spinal fusion is the usual treatment for this problem.
The authors advise repair of the pars defect is best whenever possible. This can be done when there is either no slippage or low-grade spondylolisthesis. With a pars repair, movement can be preserved. Loss of spinal motion, which occurs with fusion, is avoided. Several methods of pars defect repair are described. Screws, wires, or hooks can be used.
Spinal fusion is more clearly needed for children and teens with high-grade spondylolisthesis. High-grade means that 50 per cent or more of the bone has slipped forward. Fusion is recommended even if the child doesn't have any symptoms. The nerve roots can be stretched or compressed when the vertebra slips forward this much. Permanent neurologic damage can occur.
The authors suggest a careful and detailed physical exam before doing surgery on these patients. X-ray analysis is also important. The surgeon must look at the degree and angle of slippage and pelvic position.
Types of fusion such as in situ, fusion with reduction, and partial reduction and fusion and when to use each one are discussed. Some methods have higher complication rates. Ways to avoid nerve damage include proper positioning and wake up test during surgery. Proper surgical technique is also important. A second operation may be needed for children who have a complete loss of nerve function when they wake up from the operation.
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References:
Emilie V. Cheung, MD, et al. Spondylolysis and Spondylolisthesis in Children and Adolescents: II. Surgical Management. In Journal of the American Academy of Orthopaedic Surgeons. August 2006. Vol. 14. No. 8. Pp. 488-498.
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