Lumbar Spondylolysis and Spondylolisthesis Workup

  • Author: Beth B Froese, MD; Chief Editor: Rene Cailliet, MD   more...
 
Updated: Jan 18, 2012
 

Laboratory Studies

  • Laboratory studies do not help in diagnosing spondylolytic spondylolisthesis. Workup is radiographic in nature.
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Imaging Studies

  • Radiography
    • Initial workup includes anteroposterior, lateral (done while standing), and spot view radiographs of the lumbar spine and lumbosacral junction. Oblique views may provide additional information but are not obligatory. Flexion/extension views increase the sensitivity of radiographic studies and give the clinician some idea of the degree of instability that may be present. Percentage of slip and slip angle (calculated by measuring the angle formed by a line drawn from superior endplate inferiorly and the inferior endplate at the segment of involvement) are clinically valuable.
    • Radiographic studies allow visualization and grading of spondylolisthesis but may not always reveal the presence of an isolated spondylolysis (without spondylolisthesis). The 'Scottie dog' whose neck is broken can be seen on the oblique films when there is a classic spondylolysis. See the images below. Lumbar oblique radiograph showing the "Scottie DogLumbar oblique radiograph showing the "Scottie Dog." A pars defect is seen at L5. Diagram in the oblique projection shows the componDiagram in the oblique projection shows the components of the vertebrae that result in the appearance of a Scottie dog with a collar.
  • Bone scan
    • Bone scan with single-photon emission computed tomography (SPECT) imaging is helpful and often helps to direct management. See the image below. Bone scan with single-photon emission computed tomBone scan with single-photon emission computed tomography (SPECT) imaging showing acute spondylolysis
    • If the bone scan is positive, then the lesion is metabolically active. The physician may consider bracing, since healing is still in progress. A cold scan in the context of documented spondylolysis indicates that healing is complete; therefore, bracing is of limited utility.
  • Computed tomography (CT) scan[15]
    • CT scan performed with 1 mm sections, including coronal and sagittal reconstructions, allows for better visualization of the spondylolytic defect.
    • CT scan not only documents the presence and severity of spondylolysis, but it can help rule out more serious causes for a positive bone scan.
    • Myelogram/CT studies are helpful in delineating the severity of central stenosis. Nerve root cut-off often is observed in the presence of radiculopathy.
  • Magnetic resonance imaging (MRI)[15]
    • MRI may visualize edema in the marrow around the sight of an acute spondylolytic defect.
    • MRI also is helpful in identifying the presence of nerve root compression as a result of foraminal or central canal stenosis.
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Other Tests

  • Electromyography may provide 1 more modality for identifying a concomitant radiculopathy or polyradiculopathy (ie, stenosis), which may be present as a result of spondylolisthesis.
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Histologic Findings

Histologic studies completed at the sight of the spondylolisthesis reveal a fibrocartilaginous mesh that often bridges the gap between the edges of the fracture sight if actual healing does not occur.

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Contributor Information and Disclosures
Author

Beth B Froese, MD  Consulting Staff, Department of Physical Medicine and Rehabilitation, Orthopaedic Associates of DuPage, Ltd

Beth B Froese, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Medical Association, and Illinois State Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Curtis W Slipman, MD  Director, University of Pennsylvania Spine Center; Associate Professor, Department of Physical Medicine and Rehabilitation, University of Pennsylvania Medical Center

Curtis W Slipman, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, International Association for the Study of Pain, and North American Spine Society

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

Patrick M Foye, MD  Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society

Disclosure: Nothing to disclose.

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Rene Cailliet, MD  Professor-Chairman Emeritus, Department of Rehabilitation Medicine, University of Southern California School of Medicine; Former Director, Department of Rehabilitation Medicine, Santa Monica Hospital Medical Center

Rene Cailliet, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Pain Society, Association of American Medical Colleges, International Association for the Study of Pain, and Pan American Medical Association

Disclosure: Nothing to disclose.

References

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Radiograph of the lumbosacral junction showing a grade 1 spondylolytic spondylolisthesis at L5-S1.
Lumbar oblique radiograph showing the "Scottie Dog." A pars defect is seen at L5.
Bone scan with single-photon emission computed tomography (SPECT) imaging showing acute spondylolysis
Axial computed tomography (CT) scan shows bilateral spondylolysis. Note elongation of the spinal canal at this level.
Grade 4 traumatic spondylolisthesis.
Diagram in the oblique projection shows the components of the vertebrae that result in the appearance of a Scottie dog with a collar.
 
 
 
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