[Spondylolysis and spondylolisthesis during growth]

Spondylolysis and Spondylolisthesis present with typical age and activity-related issues: in newborns the pars interarticularis is always intact. Only bipedal ambulators develop spondylolysis, mostly during early childhood. Corresponding to the mechanical etiology, the incidence of spondylolysis is higher in athletes who repeatedly have to hyperextent and rotate their lumbar spine for example gymnasts, javelin throwers etc. Spondylolysis is one of the most frequent diagnosis among adolescents with lumbar back pain. However, most of the people with an interrupted Pars interarticularis (about 6% of the population) never become symptomatic or if they do, they respond very well to conservative treatment (adaptation of physical activity, active physical therapy and bracing). If pain persists in combination with an intact intervertebral disc of the slipped segment, we recommend a direct repair of the Pars interarticularis instead of an intersegmental fusion. Patients with low grade Spondylolisthesis (Meyerding I, II) require repeated radiological follow-up during growth because of the inherent risk of slip progression. If a slip of more than 50% is detected before the end of growth, operative treatment is indicated. High grade olisthesis (Meyerding III, IV) leads to anterior shift of the whole trunk, kyphosis of the slipped vertebra with subsequent compensatory lumbar hyperlordosis and flattening of the thoracic spine. Pelvic flexion is clinically evident. Reduction of the slipped and kyphotic vertebra with correction of the spinal, sacral and pelvic profile is recommended and preferable to simple fusion in situ.