Spina bifida occulta in isthmic spondylolisthesis: a surgical trap

Abstract

IntroductionSpondylolisthesis is a common aetiology of back pain in children and adolescents. Surgical treatment is frequently instituted to manage symptoms. Spina bifida occulta, which has an incidence of 5% in the general population, has been reported in one-third of patients with the isthmic type of spondylolisthesis [10]. This possible co-existence should be examined prior to surgery by pelvic outlet views, computed tomographic (CT) scanning or magnetic resonance (MR) imaging. If this is not done, significant risk exists for inadvertent damage to the dura and dural sac elements during the approach to the posterior spine. Case reportAn 11-year-old girl presented with progressive limitation of activities as a result of low back pain. Recurrent hamstring injury prevented sporting activities and ballet. Clinical examination revealed exaggerated lumbar lordosis, hamstring muscle spasm and marked restriction of forward flexion of the lumbar spine. Neurological examination was normal.Abstract An 11-year-old girl presented with symptomatic grade IIB isthmic type spondylolisthesis, with an elongated pars, confirmed on magnetic resonance imaging (MRI). Posterolateral in situ fusion of L5/S1 was performed. At surgery, a significant bony defect in the posterior aspect of S1 was noted. Awareness of this possible co-existence is paramount if iatrogenic damage to neural elements is to be avoided during surgery. Keywords

Spina Bifida Occulta with Bilateral Spondylolysis at the Thoracolumbar Junction Presenting Cauda Equina Syndrome

“…Kumar et al reported that there is a significant risk of nerve root damage during surgical exposure due to defects of the posterior elements in patients with such a coexistent lesion. Therefore, it is mandatory to be examined prior to surgery by pelvic outlet views using CT [5]. With preoperative images including MRI and CT, we were aware of the coexistence of SBO and spondylolysis at the thoracolumbar junction before surgery in the present case.…”

“…Sakai et al reported that the incidence of spondylolysis Case Reports in Orthopedics was significantly higher in patients with SBO than in those without SBO (odds ratio = 3:7) [4]. The coexistence of SBO and spondylolysis occurs at L5 in the majority of cases [2,5]. To our knowledge, no report has described the coexistence of SBO and spondylolysis at the thoracolumbar junction.…”

“…SBO is associated with spondylolysis of the lumbar spine in 11.8-35% of patients [3,4]. There are several reports of the coexistence of SBO and spondylolysis; the majority occur at L5 [2,5]. However, no report has described the coexistence of SBO and spondylolysis at the thoracolumbar junction.…”

Isolate metastasis of listhetic vertebra

“…The L5 spondylolisthesis together with the dysplasia of S1 that we found in our patient seems to further support the latter hypothesis. Indeed, it is a common the association between spondylolysis and congenital interruption of the posterior arch [9]. We cannot confirm this because of the lack of an earlier roentgenogram, but the anteriorly directed shear forces of the patient's body weight on the weakened metastatic vertebra could have worsened the slippage.…”

Transsacral transdiscal L5–S1 screws for the management of high-grade spondylolisthesis in an adolescent

“…Paper presented at the 59th Annual Meeting of the American Association of Orthopaedic Surgeons, Washington, DC, February 20-25, 1992). Other risk factors that have been identified include having first-degree relatives with slippage, 29 occult spina bifida at S-1, 19 and the presence of scoliosis.…”