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Spondylolisthesis in Children
Spondylolisthesis refers to abnormal forward slippage of one
vertebra
in the spine upon another. In children and teenagers, spondylolisthesis
is very often due to some aspect of dysplasia (abnormal formation)
of the L5-S1 area of the spine (the lowest area of the back at
the junction with the pelvis).
In most cases this means that a patient was born with a slightly
abnormal formation of the last lumbar
vertebra
(called L5) and of the sacrum.
This can lead to some loss of stability in the spine and gradual
slippage between L5 and the sacrum.
In most cases spondylolisthesis is more a condition than a true
problem and in fact may go completely unnoticed. However, cases
of repeated injury or unstable cases of spondylolisthesis may
lead to progressive slippage, pain and rarely neurologic symptoms
(leg cramping, pain, weakness?
There are several types of spondylolisthesis, the most common being
called "isthmic spondylolisthesis" which involves a separation
in the posterior portion of the vertebra.
Other types in children include the pure dysplastic forms, rarely
iatrogenic and traumatic types.
The initial evaluation in most cases includes a complete examination
and a set of X-rays. In some cases a CT scan may be performed
to clearly outline the slippage. If there is no evidence of significant
instability or nerve
irritation then spondylolisthesis is often treated by bracing
and acitivity modification.
The first step in treatment thus often
involves simple restriction of sports (spondylolisthesis is common
in gymnasts, football players and weightlifters). In rare cases
a spondylolisthesis is unstable and involves progressive slippage
of the spine with potential hazards for the nerves.
In these cases surgical treatment may be required. The goal of
operative care is usually to provide stability of the Lumbo-Sacral
area and to correct some degree of kyphosis
that is often present.
The goal of surgery is not a complete reduction
but a realignment to restore lordosis and achieve solid fusion.
Frequently
Asked Questions
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