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Evidence-Based Treatment of Spondylolysis and Spondylolisthesis

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Paediatric Orthopaedics

Abstract

Spondylolysis and spondylolisthesis are common pathological conditions affecting the lumbosacral junction and resulting in a forward displacement of lumbar vertebra number 5 (L5) in relation to the sacrum. It is a frequent cause of back pain in children and adolescents and may also produce neurological deficits or physical disability in severe forms.

Many treatment modalities have been proposed over the years but there is still no consensus on the most effective. This chapter explores the evidence that underpin the current practice for treating the various degree of severity of the condition.

In isolated spondylolysis (pars defect <3 mm) affecting L5 the treatment of choice is in situ posterolateral fusion (PLF), whereas if the isthmic lesion involves levels proximal to L5 pars repair is recommended. In Grade I and II lumbosacral spondylolisthesis the preferred treatment is in situ non-instrumented PLF supplemented by brace support for 4 months. In Grade IV lumbosacral spondylolisthesis which does not produce global sagittal and spino-pelvic imbalance the recommended treatment is in situ un-instrumented PLF or instrumented posterior spinal fusion. In the presence of Grade IV or reducible Grade V lumbosacral spondylolisthesis, the preferred treatment options include either reduction of L5 and instrumented circumferential fusion or instrumented posterior spinal fusion using the transfixation lumbosacral technique. Finally, in fixed lumbosacral spondyloptosis (Grade V spondylolisthesis) the recommended treatment is an L5 vertebrectomy and L4/S1 anterior/posterior fusion (Table 26.1).

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  1. Royal Hospital for Sick Children, Edinburgh, UK

    Athanasios I. Tsirikos & George Mataliotakis

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  1. Athanasios I. Tsirikos
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  1. Royal Manchester Children’s Hospital, Manchester, United Kingdom

    Sattar Alshryda

  2. Sidra Medical and Research Center, Doha, Qatar

    James S. Huntley

  3. Queen Elizabeth Hospital, Gateshead, United Kingdom

    Paul A. Banaszkiewicz

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Tsirikos, A.I., Mataliotakis, G. (2017). Evidence-Based Treatment of Spondylolysis and Spondylolisthesis. In: Alshryda, S., Huntley, J., Banaszkiewicz, P. (eds) Paediatric Orthopaedics. Springer, Cham. https://doi.org/10.1007/978-3-319-41142-2_26

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