Spondylolisthesis in children and adolescents

Area of Science:

• Pediatric Orthopedics
• Spinal Surgery
• Radiology

Background:

• Isthmic spondylolisthesis affects 4.4% of children, typically presenting as a benign condition.
• Mild to moderate vertebral slips often result in minimal or no symptoms in affected individuals.
• Early radiological monitoring is crucial for young children experiencing slips to track potential progression.

Purpose of the Study:

• To outline the management strategies for pediatric isthmic spondylolisthesis.
• To define indications for surgical intervention based on slip severity.
• To review treatment outcomes for various surgical techniques.

Main Methods:

• Non-operative pain management for mild slips in children and adolescents.
• Radiological follow-up to monitor slip progression before skeletal maturity.
• Surgical considerations including segmental fusion (posterolateral, anterior, or combined) for progressive or severe slips.

Main Results:

• Uninstrumented posterolateral fusion is effective for slips up to 50%, yielding satisfactory results in 80-90% of cases.
• Severe slips (>50%) may necessitate anterior or combined fusion to address lumbosacral kyphosis.
• Slip reduction with internal fixation is an option but carries higher risks without proven superior outcomes compared to in situ fusion.

Conclusions:

• Non-operative management is the primary approach for mild pediatric isthmic spondylolisthesis.
• Surgical fusion is indicated for slips exceeding 25% or those unresponsive to conservative care.
• While slip reduction is possible, in situ fusion remains a reliable option with good outcomes.