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- Bony defect at the pars interarticularis (the isthmus of bone between the superior and inferior facets)
- Can be unilateral or bilateral
- Bilateral form has a much higher likelihood of slippage or spondylolisthesis than the unilateral form.
- The slipping forward of 1 vertebra upon another
- Spondylolysis can contribute to spondylolisthesis, which is noted in ∼5% of the population. It is 2–4 times more common in males.
- Of those with spondylolysis, 50% will have some degree of spondylolisthesis develop during their lifetime, and 50% of those will be symptomatic:
- Literature does not associate athletic activity with increased slippage.
- Spondylolisthesis predisposes to nerve root impingement and frequently sciatica.
- Type 1—dysplastic: Congenital defect of the neural arch or intra-articular facets is often associated with spina bifida occulta
- Type 2—isthmic: Stress fracture from repetitive microtrauma through the neural arch
- Type 3—degenerative: Long-standing segmental instability
- Type 4—traumatic
- Type 5—pathologic: Generalized or focal bone disease
- Spondylolisthesis is divided into 4 grades based on degree of slippage (Meyerding grading system):
- Grade I: Up to 25% of the vertebral body width
- Grade II: 26–50% of vertebral body width
- Grade III: 51–75% of vertebral body width
- Grade IV: 76–100% of vertebral body width
- The most common location for spondylolisthesis is L5 displaced on the sacrum (85–95%), followed by L4 on L5.
- Spondylolysis is one of the most common causes of serious low back pain in children, although it is most often asymptomatic.
- Symptoms most often present during adolescent growth spurt from age 10–15 yr.
- Seen commonly in athletic teens; particularly in sports involving back hyperextension (e.g., gymnastics, diving, football).
- Acute symptoms are related to trauma.
Unknown; theories include congenital pars anomalies, alterations in bone density, and recurrent subclinical stress injury.