eMedicine Specialties > Orthopedic Surgery > Spine

Spondylolisthesis, Spondylolysis, and Spondylosis: Workup

Author: Amir Vokshoor, MD, Staff Neurosurgeon, Department of Neurosurgery, Spine Surgeon, Diagnostic and Interventional Spinal Care, St John's Health Center
Contributor Information and Disclosures

Updated: Jan 12, 2009

Workup

Laboratory Studies

  • Obtain routine preoperative laboratory tests for patients undergoing surgery.

Imaging Studies



Spondylolisthesis, spondylolysis, and spondylosis...

Spondylolisthesis, spondylolysis, and spondylosis. Isthmic spondylolisthesis (type IIa) with grade 2 slippage of L5 over S1 and spondylolysis (lytic pars defect) is depicted posteriorly.

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Spondylolisthesis, spondylolysis, and spondylosis...

Spondylolisthesis, spondylolysis, and spondylosis. Isthmic spondylolisthesis (type IIa) with grade 2 slippage of L5 over S1 and spondylolysis (lytic pars defect) is depicted posteriorly.


Spondylolisthesis, spondylolysis, and spondylosis...

Spondylolisthesis, spondylolysis, and spondylosis. Although interbody devices afford immediate stability to the anterior column, their use as stand-alone devices has been associated with pseudoarthrosis. Thus, concomitant posterior fixation is often used to augment their stability.

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Spondylolisthesis, spondylolysis, and spondylosis...

Spondylolisthesis, spondylolysis, and spondylosis. Although interbody devices afford immediate stability to the anterior column, their use as stand-alone devices has been associated with pseudoarthrosis. Thus, concomitant posterior fixation is often used to augment their stability.


  • Isthmic defects are best observed on oblique lumbar radiographs. Lateral plain radiographs with flexion and extension views are the most common studies used to demonstrate segmental instability. Some practitioners advocate the use of lateral bending films as well, especially in persons with degenerative listhesis and scoliosis.
  • Although CT scan is poor for demonstrating spondylolisthesis, it is useful in demonstrating pars interarticularis defects, facet arthropathy, canal diameter, foraminal stenosis, and disc herniation. When combined with myelography (static or dynamic flexion and extension views), CT scan may demonstrate evidence of nerve root compression and concomitant instability. Myelography is generally not indicated unless neurologic signs or pain unexplained by findings other imaging methods exists.
  • MRI is most sensitive in demonstrating soft tissues and ascertaining the presence of central and foraminal stenosis. It also can demonstrate endplate reactive changes (Modic types I and II) observed in individuals with degenerative spondylolistheses. Use of MRI in isthmic and dysplastic types is limited.
  • Bone scan can be very useful in demonstrating acute fracture of the pars interarticularis in persons with isthmic-type spondylolisthesis. It is also used in degenerative-type slips to reveal any acute reaction, although this has low specificity.
  • The use of discography is advocated by some in individuals with degenerative disc disease with low back pain due to intradiscal pathology. Patients with multilevel disc degeneration spanning long segments of the spinal column may benefit from provocative discography in order to limit the levels fused to the symptomatic levels.
  • Myelography is usually performed through a transcutaneous subarachnoid injection of radiopaque dye. When combined with CT scan, myelography is very specific for central, lateral recess, and foraminal stenosis. Dynamic imaging (with flexion and extension lateral radiographs) also can be obtained, in which the dye column characterizes the position of the neural elements during motion.

More on Spondylolisthesis, Spondylolysis, and Spondylosis

Overview: Spondylolisthesis, Spondylolysis, and Spondylosis
Workup: Spondylolisthesis, Spondylolysis, and Spondylosis
Treatment: Spondylolisthesis, Spondylolysis, and Spondylosis
Follow-up: Spondylolisthesis, Spondylolysis, and Spondylosis
Multimedia: Spondylolisthesis, Spondylolysis, and Spondylosis
References
Further Reading
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Keywords

spondylolisthesis, spondylolysis, spondylosis, subluxation, spondyloptosis, spine, vertebra, vertebrae, spinal instability, radiculopathy, neurogenic claudication, postural abnormality, gait abnormality, slip progression, back pain

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Contributor Information and Disclosures

Author

Amir Vokshoor, MD, Staff Neurosurgeon, Department of Neurosurgery, Spine Surgeon, Diagnostic and Interventional Spinal Care, St John's Health Center
Amir Vokshoor, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, American Medical Association, and North American Spine Society
Disclosure: Nothing to disclose.

Medical Editor

Lee H Riley III, MD, Chief, Division of Orthopedic Spine Surgery, Assistant Professor, Departments of Orthopedic Surgery and Neurosurgery, Johns Hopkins University
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

William O Shaffer, MD, Professor, Vice-Chairman and Residency Program Director, Department of Orthopedic Surgery, University of Kentucky at Lexington
William O Shaffer, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, International Society for the Study of the Lumbar Spine, Kentucky Medical Association, Kentucky Orthopaedic Society, North American Spine Society, Southern Medical Association, and Southern Orthopaedic Association
Disclosure: DePuySpine 1997-2007 (not presently) Royalty Consulting; DePuySpine 2002-2007 (closed) Grant/research funds SacroPelvic Instrumentation Biomechanical Study; DePuyBiologics 2005-2008 (closed) Grant/research funds Healos study just closed; No present Industry grants or funds. None None

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Mary Ann E Keenan, MD, Professor, Vice Chair for Graduate Medical Education, Department of Orthopedic Surgery, University of Pennsylvania School of Medicine; Chief of Neuro-Orthopedics Program, Department of Orthopedic Surgery, Hospital of the University of Pennsylvania
Mary Ann E Keenan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, American Society for Surgery of the Hand, and Orthopaedic Rehabilitation Association
Disclosure: Nothing to disclose.

 
 
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