Congenital Fractures


Spondylolytic Spondylolisthesis Fractures

There are multiple classification of lumbar and lumbo-sacral spondylolisthesis. As such clinically, in the adults the distinction between isthmic and congenital spondylolisthesis is considered to be theoretical and anatomic (Ref). We have used the term lytic spondylolisthesis in adults who have presented with lytic defect in the pars to distinguish them from patients with attenuated pars interarticularis and patients with degenerative, post surgical, post traumatic, pathological spondylolisthesis and that occurring in patients with widespread or localised bone.

Several theories on the causes of pain in patients with spondylolytic spondylolisthesis have been proposed. These include isthmic defect, the intervertebral disc, adjacent facet joint and stenotic changes which have been implicated in the causation of back and sciatica syndrome. Histological studies have demonstrated the presence of nociceptive fibres in the pars defect. Communication between the facet capsule and the isthmic defect which appear to occur because of capsular tears. Kirkaldy-Willis has drawn attention to the lateral recess and foraminal stenosis with entrapment of the exiting nerve by the pars interarticularis. Fibrosis around the exiting nerve following laminectomy and fusions in patients with spondylolisthesis provides another source of pain.

The origin of back pain or clinical symptoms of neural compression can be elusive, especially when adjacent discs demonstrate dehydration on the MR scans. Upon the failure of conservative treatment, patients with lytic spondylolisthesis, back pain and radicular symptoms are usually treated with decompression with or without fusion. Good to excellent outcome of surgery have varied from 70 to 90%. This report presents the outcome of a prospectively designed study of endoscopic foraminoplasty in symptomatic patients presenting with lytic spondylolisthesis.