Spondylolysis and Spondylolisthesis in Adolescents and Children


Spondylolisthesis is a condition in which one vertebra slips over the subadjacent caudal vertebra. Spondylolysis involves a lytic defect in the pars interarticularis region of a vertebra. Isthmic spondylolisthesis is the type most commonly seen in young patients, whereas dysplastic spondylolisthesis is rarer. Spondylolisthesis in children and adolescents is thought to be influenced in part by gender: Dysplastic spondylolisthesis is twice as common in females as in males, and high-grade spondylolisthesis is four times as common in females. Furthermore, spondylolisthesis and spondylolysis have been found to increase in adolescents and children who participate in active sports that accentuate lumbar lordosis or involve repetitive hyperextension. Age of presentation is the most important factor in predicting severity of symptoms and the need for treatment. Management options for the symptomatic patient include surgical or nonsurgical treatment, depending on symptomatic intensity. Although direct repair is advantageous for symptomatic spondylolysis and low-grade spondylolisthesis, in situ posterolateral arthrodesis involving a Wiltse approach is an alternative surgical option for low-grade spondylolisthesis. Meanwhile, surgical treatment of high-grade spondylolisthesis continues to be a controversial topic in the orthopaedic community: Optimal method of treatment, the need for reduction, and the timing of treatment are the chief points of debate.

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