Lumbar spondylolysis / spondylolisthesis

is a defect in the pars interarticularis. If the fracture defect widens and allows the superior
segment to slip on the inferior segment, the result is a spondylolisthesis.

MECHANISM OF INJURY •

usually caused by forced extension of the lumbar spine. It occurs most frequently at L5, followed
by L4,and more rarely at L3 or above. Less than half of the people with a spondylolysis will develop a
spondylolisthesis.

• Spondylolisthesis can be the result of trauma, degenerative processes, or be congenital.

The four grades of spondylolisthesisare as follows: °°

0% to 25% grade 1

25% to 50% a grade 2

50% to 75% a grade 3

Over 75% a grade 4

5 types (RARE/COMMON)

1. Dysplastic- rare and usually has rapidly progressing neurological deficits. Difficult to treat
surgically
2. Isthmic- pars defect that may be from a stress fracture from repetitive hyperextension that
causes shear of posterior element
3. Degenerative- slippage of superior vertebral segment because of facet arthritis
4. Traumatic- cause acute fracture of the facet or pars interarticularis
5. Pathological- caused by damage to the posterior elements from tumor, metastases, or
metabolic bone disease.

EPIDEMIOLOGY:

-acquired at ages 6-16

- older adults

S/Sx

Most people with this kind of condition have ni symptoms

Report of mild to moderate back and leg pain that is increased with extension positions.

PE:

Provocation test (local pain)

Prone instability test --The patient lies prone. A posterior-toanterior directed force is applied
to the unstable segment.If pain is produced, the patient is instructed to slightly extend
theirlegs. The posterior-to-anterior force is applied onceagain. If symptoms are
reduced, then instability may be present.