jsmc-10107

RISK FACTORS AND CONSERVATIVE MANAGEMENT OF SPONDYLOLYSIS AND SPONDYLOLISTHESIS GRADE I AND II

Ari Sami Hussain Nadhim a, b, Nabaz M. Mustafa b and Seerwan O. Hasan b

a Department of Surgery, College of Medicine, University of Sulaimani.

b Shahid Dr. Aso Neurosurgical and Ophthalmological Hospital and Surgical Emergency Hospital in Sulaymaniyah city, Kurdistan region, Iraq.

Submitted: 27/7/2016; Accepted: 7/3/2017; Published: 1/6/2017

DOI Link: https://doi.org/10.17656/jsmc.10107

ABSTRACT

Background

Spondylolysis is a fracture of pars interarticularis without slippage of the vertebral bodies. Spondylolisthesis is anterior slippage of one vertebral body on to the immediate inferior vertebral body. The conservative treatment of spondylolysis and low-grade spondylolisthesis is preferable initial step in the management.

Objectives

The purposes were to find the risk factors for lumbar spondylolysis and spondylolisthesis and the plausibility of conservative management of them.

Materials and Methods

Prospective cohort study of a series of (100) patients performed. Each followed up for six consecutive months during 2012-2014. Failure of conservative treatment necessitated surgical intervention. Inclusion criteria for the patients to be included in the study were that the patient needed to be afflicted with Spondylolysis, and/or spondylolisthesis Meyerding grade I and II. We assessed the grades of slippage by Meyerding grading system

Results

Patients included in the study were 14% males and 86% females, and the mean and SD (Standard Deviation) age were (43.92±13.83) years. The Body Mass Index (BMI) of the patients were 55% overweight, and 17% obese, with a significant P-value of (<0.001). The mean±SD body height was (166.75±6.94 cm). There was history of trauma in 63% patients, and the level of pars fracture was L5 in 65%, L4 in 30%, and L3 in 4%. The degrees of vertebral slippage were 59% grade I, 34% spondylolysis, 7% grade II. Eleven (11%) of patients were indicated for surgery. Transpedicular screw fixation and fusion was performed for nine patients and two of them refused surgery.

Conclusion

Conservative treatment is preferable as an initial step in the management of spondylolysis and spondylolisthesis Grade I and II if there were no neurological deficits.

KEYWORDS

Meyerding grading; Spondylolisthesis; Spondylolysis

References

1. Winn HR. Youmans neurological surgery. 6th ed. Philadelphia, PA: Elsevier; 2011.

2. Greenberg MS. Handbook of neurosurgery. 7th ed. New York, NY: Thieme Medical Publishers; 2010.

3. Dantas FLR, Prandini MN, Ferreira MAT. Comparison between posterior lumbar fusion with pedicle screws and posterior lumbar interbody fusion with pedicle screws in adult spondylolisthesis. Arq Neuropsiquiatr. 2007;65(3-B):764-770.

4. Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008;17:327–335. DOI 10.1007/s00586-007-0543-3.

5. Lee HJ, Seo JC, Kwak MA, Park SH, Min BM, Cho MS, et al. Acupuncture for low back pain due to spondylolisthesis: study protocol for a randomized controlled pilot trial. Trials. 2014;15:105. doi: 10.1186/1745-6215-15-105.

6. Huang KY, Lin RM, Lee YL, Li JD. Factors affecting disability and physical function in degenerative lumbar spondylolisthesis of L4–5: evaluation with axially loaded MRI. Eur Spine J. 2009;18:1851–1857. DOI 10.1007/s00586-009-1059-9.

7. Garet M, Reiman, MP, Mathers J, Sylvian J. Nonoperative Treatment in Lumbar Spondylolysis and Spondylolisthesis: A Systematic Review. SAGE. 2013;5(3):225-232. DOI: 10.1177/1941738113480936.

8. Niggemann P, Kuchta J, Grosskurth D, Beyer HK, Hoeffer J, Delank KS. Spondylolysis and isthmic spondylolisthesis: impact of vertebral hypoplasia on the use of the Meyerding classification. The British Journal of Radiology. 2012;85:358–362. DOI: 10.1259/bjr/60355971.

9. Mizuno J, Nakagawa H. Threaded Fusion Cage for Lumbar Spondylolisthesis. Neurol Med Chir (Tokyo). 1998;38(3):155-160.

10.Baksi DP. Sacrospinalis muscle-pedicle bone graft in posterolateral fusion for spondylolisthesis. International Orthopaedics. 1998;22(4):234-240. doi:10.1007/s002640050249.

11. Ka-Siong Kho V, Chen W-C. Posterolateral fusion using laminectomy bone chips in the treatment of lumbar spondylolisthesis. International Orthopaedics. 2008;32(1):115-119. doi:10.1007/s00264-006-0274-9.

12. Zagra A, Giudici F, Minoia L, Corriero AS, Zagra L. Long-term results of pediculo-body fixation and posterolateral fusion for lumbar spondylolisthesis. Eur Spine J. 2009;18 (Suppl 1):S151–S155. DOI 10.1007/s00586-009-0997-6.

13. Duke Orthopedics. Angular Slipping in Spondylolisthesis. Weblog. Available from: http://www.wheelessonline.com/ortho/angular_slipping_in_spondylolisthesis; 2011, [accessed 15th May 2014].

14. Alfieri A, Gazzeri R, Prell J, Röllinghoff M. The current management of lumbar spondylolisthesis. J Neurosurg Sci. 2013;57(2):103-113.

15. Kim NH, Lee JW. The relationship between isthmic and degenerative spondylolisthesis and the configuration of the lamina and facet joints. Eur Spine J. 1995;4(3), 139–144.

16. Leone A, Guglielmi G, Cassar-Pullicino VN, Bonomo L. Lumbar intervertebral instability: a review. Radiology. 2007;245(1):62–77. DOI: http://dx.doi.org/10.1148/radiol.2451051359.

17. Haun DW, Kettner NW. Spondylolysis and spondylolisthesis: a narrative review of etiology, diagnosis, and conservative management. JOURNAL OF CHIROPRACTIC MEDICINE. 2005;4(4):206-2017. 0899-3467/Clinical Update/1002-049$3.00/0.

18. Metz LN, Deviren V. Low-grade spondylolisthesis. Neurosurg Clin N Am. 2007;18(2):237-248.

19. Dunn AS, Baylis S, Ryan D. Chiropractic management of mechanical low back pain secondary to multiple-level lumbar spondylolysis with spondylolisthesis in a United States Marine Corps veteran: a case report. J Chiropr Med. 2009;8(3):125–130. doi: 10.1016/j.jcm.2009.04.003.

20. Denard PJ, Holton KF, Miller J, et al. Lumbar spondylolisthesis among elderly men: prevalence, correlates and progression. Spine (Phila Pa 1976). 2010;35(10), 1072–1078. doi:10.1097/BRS.0b013e3181bd9e19.

21. U.S. department of health, education, and welfare public health service. Weight, Height and Selected Body Dimensions of Adult, United States, 1960-1962. Washington, D.C. National center for health statistics; 1965.

22. Gaetani P, Aimar E, Panella L, Levi D, Tancioni F, Ieva AD, et al. Functional disability after instrumented stabilization in lumbar degenerative spondylolisthesis: a follow-up study. Funct Neurol. 2006;21(1):31-37.

23. Giudici F, Minoia L, Archetti M, Corriero AS, Zagra A. Long-term results of the direct repair of spondylolisthesis. Eur Spine J. 2011;20 (Suppl 1):S115–S120. DOI 10.1007/s00586-011-1759-9.

24. Matsunaga S, Ijiri K, Hayashi K. Nonsurgically managed patients with degenerative spondylolisthesis: a 10- to 18-year follow-up study. J Neurosurg (Spine 2). 2000;93:194-198.

25. Bouras T, Korovessis P. Management of spondylolysis and low-grade spondylolisthesis in fine athletes. A comprehensive review. Eur J Orthop Surg Traumatol, 2015;25(Suppl 1):S167-75. doi: 10.1007/s00590-014-1560-7. Epub 2014 Nov 14.

26. Bookhout MR. Evaluation and conservative management of spondylolisthesis. J Back MusculoskeletRehabil. 1993;3(4):24-31. doi: 10.3233/BMR-1993-3406.

Full Text

This work is licensed under a Creative Commons Attribution 4.0 International License.