Pediatric Spondylolysis and Spondylolisthesis

Abstract

Spondylolisthesis is the slipping of one vertebra on another. Spondylolysis is a disruption of the pars interarticularis. These two conditions can exist concomitantly or separately and are often seen in asymptomatic patients. However, these diagnoses are usually made because of complaints of back pain and/or deformity. Spondylolysis is associated with activities that involve repeated hyperextension of the spine. Spondylolisthesis can be of the developmental or acquired type. Severe slips are seen with the developmental type, and high-grade slips cause significant back deformity, loss of normal spinal alignment, and gait abnormalities. Diagnosis is made with plain radiographs with additional advanced imaging as indicated. The natural history is somewhat nebulous as many patients with even high-grade slips remain asymptomatic. Yet patients who only have spondylolysis may have severe low-back pain. The mainstay of treatment is periodic rest, physical therapy, and nonsteroidals. Persistent symptoms may require surgical treatment to either repair the pars in spondylolysis or to stabilize the spondylolisthesis with a fusion.