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Spondylolysis and spondylolisthesis

H Saraste1

  • 1Department of Orthopedics, Karolinska Hospital, Stockholm, Sweden.

Acta Orthopaedica Scandinavica. Supplementum
|January 1, 1993
PubMed
Summary

Spondylolysis, often constitutional, usually presents after slippage. Disc pathology can worsen it, but neurological deficits are rare. Treatment depends on age and symptoms, with in situ fusion effective for younger patients.

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Area of Science:

  • Orthopedics
  • Neurosurgery
  • Spinal Surgery

Background:

  • Spondylolysis is a common spinal condition, frequently presenting after significant slippage.
  • Constitutional factors are the primary cause, with disc pathology a potential cause of progression.
  • Neurological deficits are uncommon, but high-grade olisthesis and L4 level are risk factors for future back pain.

Purpose of the Study:

  • To review the management of spondylolysis and olisthesis.
  • To identify risk factors for progression and future pain.
  • To evaluate surgical outcomes based on patient demographics and surgical techniques.

Main Methods:

  • Review of clinical presentations, progression factors, and treatment outcomes for spondylolysis and olisthesis.
  • Analysis of surgical techniques including posterolateral fusion in situ with and without instrumentation, and reduction.
  • Stratification of outcomes based on patient age and olisthesis grade.

Main Results:

  • Spondylolysis commonly presents late, with progression often linked to disc pathology.
  • High-degree olisthesis and L4 level are identified as risk factors for subsequent back pain.
  • Posterolateral fusion in situ without instrumentation yields good results in younger patients; older patients benefit from instrumentation.
  • Reduction is not routinely recommended.

Conclusions:

  • Asymptomatic spondylolysis with or without olisthesis requires no treatment.
  • Surgical management should be tailored to patient age, with fusion in situ being effective for younger individuals.
  • Instrumentation is beneficial for older patients undergoing fusion for spondylolysis and olisthesis.

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