Dr. Ebraheim’s educational animated video describes the difference between Spondylolysis, Spondylolisthesis, and Spondylitis & Spondylosis - lumbar spine.
Spondylolysis is the term used to describe the anatomic defect or break of the pars interarticularis of the vertebral arch. Spondylolysis usually occurs in the lower lumbar spine, especially L5 vertebrae. Spondylolysis most commonly occurs with the fifth lumbar vertebrae (L5). It usually appears as a radiolucent gap on lateral X-ray. It occurs in about 5% of the population. It is not present at birth but develops over time. The condition may run in families. Spondylolysis is usually caused due to repetitive trauma, especially hyperextension (female gymnastics, tennis players, weight lifters, football lineman, etc.). Repetitive trauma may cause stress fractures.
The condition is usually asymptomatic. The patient may have activity related lower back pain or hamstring tightness.
AP and lateral x-rays may show defect in about 80% of the cases. It may show as a defect with or without sclerosis. Oblique view may add another 15% more to the diagnosis. The “scotty dog sign” refers to the normal appearance of the lumbar spine when seen on oblique radiographic projection. If Spondylolysis is present, the pars interarticularis, or the neck of the dog, will have a defect or break. It often looks as if the dog has a collar around the neck.
CT scan is the best study especially to check for healing. A SPECT scan is the best study when x-rays are negative and you strongly suspect the condition. Lysis means dissolve or a defect from a stress and it may be occult.
Spondylolysis is not to be confused with spondylolisthesis, spondylitis and spondylosis. If the stress fracture weakens the bone so much that it is unable to maintain its proper position, the vertebra can start to shift out of place. This condition of vertebral slippage is called spondylolisthesis.
This condition of the forward slipping of the vertebrae (one bone slides forward over the bone below it) may affect the nerves.
Types of spondylolisthesis:
•Congenital
•Isthmic: most common and usually occurs due to pars defect (L5-common)
•Degenerative: occurs as a result of facet arthritis. Occurs in African American females older than 50 years. Usually affects the L4-L5 level. Usually the slip is not bad and rarely exceeds 30%.Usually associated with instability and lumbar stenosis. May need flexion/ extension x-ray views to check for instability.
Grades of spondylolisthesis:
•Type I (less than 25%)
•Type II (25-50%)
•Type III (50-75%)
•Type VI (75-100%)
•Type V (spondyloptosis).
Lateral view x-ray will measure the grade and the slip angle. Pelvic incidence= pelvic tilt plus sacral slope.
Surgical consideration in treatment:
•L1-L4 : repair the defect if conservative treatment fails.
•L5-S1: in situ fusion in lower grades. In high grade isthmic slippage, fusion from L5-S1. Reduction of the slip may cause L5 nerve root injury.
Spondylitis means inflammation of the vertebrae. It may affect the lower spine or the cervical spine.
Examination:
•Pott’s disease (TB of the spine).
•Ankylosing spondylitis.
Ankylosing spondylitis is an autoimmune disease involving the spine and sacroiliac joints and is therefore a form of spondylarthritis. The spine goes from the stage of inflammation to the stage of fusion.
Spondylosis. The space between the two adjacent vertebrae narrow (degenerative osteoarthritis of the joints between the vertebrae and/or neural foramina) which leads to compression of the nerve roots. Compression of the nerve roots I called radiculopathy. Radiculopathy will lead to pain, sensory and motor changes. In the cervical spine, compression of the cord from arthritis can lead to myelopathy.
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9 июл 2024
