Spondylolysis and spondylolisthesis in the pediatric and adolescent population

Abstract

This article is a review of spondylolysis and spondylolisthesis in younger age groups. Since Herbinaux first described the pathology (1782), many classifications and theories of etiopathogenesis have been proposed. The congenital and isthmic types, as classified by Wiltse, are the most frequent in younger age groups, but the postsurgical progressive forms (3-5%) have been described as increasing in frequency secondary to neoplastic surgery in children. The general incidence is 4-5% at the age of 6 years, and in 30-50% of cases these types do not progress to spondylolisthesis. Most cases are asymptomatic (80%). Standard radiographic examinations (A-P, L, Oblique) are helpful in diagnosis and can suggest what the prognosis will be in terms of the evolution, and also what treatment is indicated (degree of slippage, slip angle, lumbar and lumbosacral index, SPTI). A bone scan (PBS and SPECT) is useful in the early stages of spondylolysis (pre-spondylosis). Although the CT scan is the most accurate examination, MRI is becoming important for diagnosis because of the frequency with which it is used as a primary investigation method. Depending on patient age, progression, degree of slippage, and symptoms, different therapeutic approaches have been proposed and are described in this paper.

Children and Adolescents With Low Back Pain: A Descriptive Study of Physical Examination and Outcome Measurement

“…7 The predominance of this research has focused primarily on developing epidemiological profiles, examining prevalent risk factors, and identifying important prognostic 2,3,5,7,45,64 Little research has been devoted to examining the management of these patients and that which has been done appears to focus primarily on conditions such as spondylolisthesis and scoliosis. 13,47,54 Now that the occurrence of LBP related to nonspecific pathologies in adolescents is recognized, what is currently lacking in the literature is information related to the appropriate subgrouping and conservative clinical management of these patients.…”

Vertebral body bone mineral density in patients with lumbar spondylolysis: a quantitative CT

“…The etiopathogenesis of spondylolysis is still not fully understood (7). Theories based on dysplastic/congenital, traumatic, or other factors such as Looser zone in osteomalacia are being discussed.…”

Lumbarspondylolysis: a review

“…This is defined as: the complete bilateral fractures of the pars interarticularis resulting in the anterior slippage of the vertebra. Predicting risk factors for progression of the slip to Spondylolisthesis has proven to be difficult (6,8).…”