Spondylolisthesis, Spondylolysis, and Spondylosis Workup

  • Author: Amir Vokshoor, MD; Chief Editor: Mary Ann E Keenan, MD   more...
 
Updated: Feb 7, 2012
 

Laboratory Studies

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Imaging Studies

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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.
  • 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.
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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.

Specialty Editor Board

Lee H Riley III, MD  Chief, Division of Orthopedic Spine Surgery, Associate Professor, Departments of Orthopedic Surgery and Neurosurgery, Johns Hopkins University School of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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; DePuySpine 2009 Consulting fee Design of Offset Modification of Expedium

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

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.

Additional Contributors

www.neurosurgicalspine.com patient education

References

  1. Wiltse LL, Newman PH, Macnab I. Classification of spondylolisis and spondylolisthesis. Clin Orthop. Jun 1976;(117):23-9. [Medline].

  2. Ikuta K, Tono O, Oga M. Clinical outcome of microendoscopic posterior decompression for spinal stenosis associated with degenerative spondylolisthesis--minimum 2-year outcome of 37 patients. Minim Invasive Neurosurg. Oct 2008;51(5):267-71. [Medline].

  3. Schaeren S, Broger I, Jeanneret B. Minimum four-year follow-up of spinal stenosis with degenerative spondylolisthesis treated with decompression and dynamic stabilization. Spine. Aug 15 2008;33(18):E636-42. [Medline].

  4. Yan DL, Pei FX, Li J, Soo CL. Comparative study of PILF and TLIF treatment in adult degenerative spondylolisthesis. Eur Spine J. Oct 2008;17(10):1311-6. [Medline].

  5. Hu SS, Tribus CB, Diab M, Ghanayem AJ. Spondylolisthesis and spondylolysis. Instr Course Lect. 2008;57:431-45. [Medline].

  6. Majid K, Fischgrund JS. Degenerative lumbar spondylolisthesis: trends in management. J Am Acad Orthop Surg. Apr 2008;16(4):208-15. [Medline].

  7. Acosta FL Jr, Ames CP, Chou D. Operative management of adult high-grade lumbosacral spondylolisthesis. Neurosurg Clin N Am. Apr 2007;18(2):249-54. [Medline].

  8. Weinstein JN, Lurie JD, Tosteson TD, Hanscom B, Tosteson AN, Blood EA, et al. Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med. May 31 2007;356(22):2257-70. [Medline].

  9. Tosteson AN, Tosteson TD, Lurie JD, et al. Comparative effectiveness evidence from the spine patient outcomes research trial: surgical versus nonoperative care for spinal stenosis, degenerative spondylolisthesis, and intervertebral disc herniation. Spine (Phila Pa 1976). Nov 15 2011;36(24):2061-8. [Medline].

  10. Takahashi T, Hanakita J, Minami M, Kitahama Y, Kuraishi K, Watanabe M, et al. Clinical outcomes and adverse events following transforaminal interbody fusion for lumbar degenerative spondylolisthesis in elderly patients. Neurol Med Chir (Tokyo). 2011;51(12):829-35. [Medline].

  11. Dean CL, Gabriel JP, Cassinelli EH, Bolesta MJ, Bohlman HH. Degenerative spondylolisthesis of the cervical spine: analysis of 58 patients treated with anterior cervical decompression and fusion. Spine J. Dec 24 2008;[Medline].

  12. Harris EB, Sayadipour A, Massey P, Duplantier NL, Anderson DG. Mini-open versus open decompression and fusion for lumbar degenerative spondylolisthesis with stenosis. Am J Orthop (Belle Mead NJ). Dec 2011;40(12):E257-61. [Medline].

  13. Zdeblick TA. A prospective, randomized study of lumbar fusion. Preliminary results. Spine. Jun 15 1993;18(8):983-91. [Medline].

  14. Zdeblick TA. The treatment of degenerative lumbar disorders. A critical review of the literature. Spine. Dec 15 1995;20(24 Suppl):126S-137S. [Medline].

  15. Franklin GM, Haug J, Heyer NJ. Outcome of lumbar fusion in Washington State workers' compensation. Spine. Sep 1 1994;19(17):1897-903; discussion 1904. [Medline].

  16. Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am. Jul 1991;73(6):802-8. [Medline].

  17. Radcliff KE, Rihn J, Hilibrand A, et al. Does the duration of symptoms in patients with spinal stenosis and degenerative spondylolisthesis affect outcomes?: analysis of the spine outcomes research trial. Spine (Phila Pa 1976). Dec 1 2011;36(25):2197-210. [Medline].

  18. Blumenthal SL, Baker J, Dossett A. The role of anterior lumbar fusion for internal disc disruption. Spine. May 1988;13(5):566-9. [Medline].

  19. Bridwell KH, Sedgewick TA, O'Brien MF, et al. The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord. Dec 1993;6(6):461-72. [Medline].

  20. Caputy AJ, Luessenhop AJ. Long-term evaluation of decompressive surgery for degenerative lumbar stenosis. J Neurosurg. Nov 1992;77(5):669-76. [Medline].

  21. Crock HV. Internal disc disruption. A challenge to disc prolapse fifty years on. Spine. Jul-Aug 1986;11(6):650-3. [Medline].

  22. Detwiler PW, Marciano FF, Porter RW. Lumbar Stenosis: indications for fusion with and without instrumentation. Neurosurg Focus. 1997;3(2):1-12.

  23. diPierro CG, Helm GA, Shaffrey CI, et al. Treatment of lumbar spinal stenosis by extensive unilateral decompression and contralateral autologous bone fusion: operative technique and results. J Neurosurg. Feb 1996;84(2):166-73. [Medline].

  24. Feffer HL, Wiesel SW, Cuckler JM, Rothman RH. Degenerative spondylolisthesis. To fuse or not to fuse. Spine. Apr 1985;10(3):287-9. [Medline].

  25. Frymoyer JW, Hanley E, Howe J. Disc excision and spine fusion in the management of lumbar disc disease. A minimum ten-year followup. Spine. Mar 1978;3(1):1-6. [Medline].

  26. Greenberg MS. Spinal stenosis. In: Handbook of Neurosurgery. 4th ed. Georg Thieme Verlag; 1997:207-217.

  27. Hanley EN Jr, Levy JA. Surgical treatment of isthmic lumbosacral spondylolisthesis. Analysis of variables influencing results. Spine. Jan 1989;14(1):48-50. [Medline].

  28. Harris IE, Weinstein SL. Long-term follow-up of patients with grade-III and IV spondylolisthesis. Treatment with and without posterior fusion. J Bone Joint Surg Am. Sep 1987;69(7):960-9. [Medline].

  29. Heller JG. The syndromes of degenerative cervical disease. Orthop Clin North Am. Jul 1992;23(3):381-94. [Medline].

  30. Johnson JR, Kirwan EO. The long-term results of fusion in situ for severe spondylolisthesis. J Bone Joint Surg Br. Jan 1983;65(1):43-6. [Medline].

  31. Johnsson KE, Uden A, Rosen I. The effect of decompression on the natural course of spinal stenosis. A comparison of surgically treated and untreated patients. Spine. Jun 1991;16(6):615-9. [Medline].

  32. Johnsson KE, Willner S, Johnsson K. Postoperative instability after decompression for lumbar spinal stenosis. Spine. Mar 1986;11(2):107-10. [Medline].

  33. Katz JN. Lumbar spinal fusion. Surgical rates, costs, and complications. Spine. Dec 15 1995;20(24 Suppl):78S-83S. [Medline].

  34. Kohno K, Kumon Y, Oka Y, et al. Evaluation of prognostic factors following expansive laminoplasty for cervical spinal stenotic myelopathy. Surg Neurol. Sep 1997;48(3):237-45. [Medline].

  35. Kumar VG, Rea GL, Mervis LJ, et al. Cervical spondylotic myelopathy: functional and radiographic long-term outcome after laminectomy and posterior fusion. Neurosurgery. Apr 1999;44(4):771-7; discussion 777-8. [Medline].

  36. Macdonald RL, Fehlings MG, Tator CH, et al. Multilevel anterior cervical corpectomy and fibular allograft fusion for cervical myelopathy. J Neurosurg. Jun 1997;86(6):990-7. [Medline].

  37. Markwalder TM. Surgical management of neurogenic claudication in 100 patients with lumbar spinal stenosis due to degenerative spondylolisthesis. Acta Neurochir. 1993;120:136-42.

  38. Mullin BB, Rea GL, Irsik R, et al. The effect of postlaminectomy spinal instability on the outcome of lumbar spinal stenosis patients. J Spinal Disord. Apr 1996;9(2):107-16. [Medline].

  39. Nasca RJ. Rationale for spinal fusion in lumbar spinal stenosis. Spine. Apr 1989;14(4):451-4. [Medline].

  40. Nasca RJ. Surgical management of lumbar spinal stenosis. Spine. Oct 1987;12(8):809-16. [Medline].

  41. Panjabi MM. Biomechanical evaluation of spinal fixation devices: I. A conceptual framework. Spine. Oct 1988;13(10):1129-34. [Medline].

  42. Panjabi MM, Krag MH, Chung TQ. Effects of disc injury on mechanical behavior of the human spine. Spine. Oct 1984;9(7):707-13. [Medline].

  43. Papadopoulos SM, Hoff JT. Anatomical treatment of cervical spondylosis. Clin Neurosurg. 1994;41:270-85. [Medline].

  44. Pappas CT, Sonntag VK. Lumbar stenosis in the elderly. Neurosurg Q. 1994;4:102-112.

  45. Rosenberg NJ. Degenerative spondylolisthesis. Predisposing factors. J Bone Joint Surg Am. Jun 1975;57(4):467-74. [Medline].

  46. Silvers HR, Lewis PJ, Asch HL. Decompressive lumbar laminectomy for spinal stenosis. J Neurosurg. May 1993;78(5):695-701. [Medline].

  47. Sonntag VK, Marciano FF. Is fusion indicated for lumbar spinal disorders?. Spine. Dec 15 1995;20(24 Suppl):138S-142S. [Medline].

  48. Stokes IA, Frymoyer JW. Segmental motion and instability. Spine. Sep 1987;12(7):688-91. [Medline].

  49. Suk SI, Lee CK, Kim WJ. Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine. Jan 15 1997;22(2):210-9; discussion 219-20. [Medline].

  50. Swezey RL, Swezey AM, Warner K. Efficacy of home cervical traction therapy. Am J Phys Med Rehabil. Jan-Feb 1999;78(1):30-2. [Medline].

  51. Teresi LM, Lufkin RB, Reicher MA, et al. Asymptomatic degenerative disk disease and spondylosis of the cervical spine: MR imaging. Radiology. Jul 1987;164(1):83-8. [Medline].

  52. Thomas NW, Rea GL, Pikul BK, et al. Quantitative outcome and radiographic comparisons between laminectomy and laminotomy in the treatment of acquired lumbar stenosis. Neurosurgery. Sep 1997;41(3):567-74; discussion 574-5. [Medline].

  53. Vaccaro AR, Garfin SR. Internal fixation (pedicle screw fixation) for fusions of the lumbar spine. Spine. Dec 15 1995;20(24 Suppl):157S-165S. [Medline].

  54. Weatherley CR, Prickett CF, O'Brien JP. Discogenic pain persisting despite solid posterior fusion. J Bone Joint Surg Br. Jan 1986;68(1):142-3. [Medline].

  55. White AA, Panjabi MM. Clinical Biomechanics of the Spine. 2nd ed. Philadelphia, Pa: Lippincott, Williams & Wilkins; 1990:342-378.

  56. Yasuma T, Koh S, Okamura T, Yamauchi Y. Histological changes in aging lumbar intervertebral discs. Their role in protrusions and prolapses. J Bone Joint Surg Am. Feb 1990;72(2):220-9. [Medline].

  57. Yu S, Haughton VM, Sether LA, et al. Criteria for classifying normal and degenerated lumbar intervertebral disks. Radiology. Feb 1989;170(2):523-6. [Medline].

 
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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. 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.
Spondylolisthesis, spondylolysis, and spondylosis. The use of direct electrical current for stimulation of fusion has been advocated by some to enhance fusion rates in patients at risk of pseudoarthrosis (ie, persons who smoke).
Spondylolisthesis, spondylolysis, and spondylosis. Spontaneous reduction of the slip (either partial or complete) has been reported by surgeons using interbody grafts after complete disc excision. In this case, the reduction was achieved immediately after the placement of the carbon fiber interbody device packed with autologous bone. The cage is outlined in Image below.
Spondylolisthesis, spondylolysis, and spondylosis. Carbon fiber interbody cage used in reduction of the slip
 
 
 
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