OKOJ, Volume 8, No. 4

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.

    • Keywords:
    • anterior spinal cord syndrome

    • Brown-Sequard syndrome

    • cauda equina syndrome

    • central spinal cord syndrome

    • complete spinal cord injury

    • conus medullaris syndrome

    • corticosteroids

    • epidural abscess

    • epidural hematoma

    • horners syndrome

    • instrumentation-related spine injury

    • intraoperative complications

    • intraoperative monitoring

    • methylprednisolone

    • motor-evoked potentials

    • neurodeficits

    • neurologic complications

    • partial spinal cord injury

    • posterior spinal cord syndrome

    • postoperative complications

    • pseudomeningoceles

    • reperfusion injury

    • root palsy

    • segmental spinal cord disorder

    • somatosensory-evoked potentials

    • spinal cord injury

    • spinal cord ischemia

    • spinal cord lesions

    • spinal cord syndromes

    • spinal nerve root injury

    • spine surgery complications

    • steroid therapy

    • stimulated electromyography

    • Subspecialty:
    • Pediatric Orthopaedics

    • Spine

Complications of Spine Surgery: Neurodeficits of the Spinal Cord and Nerve Roots

Neurodeficits associated with spinal cord injury may arise intraoperatively or postoperatively. Such neurologic complications are classified by the American Spinal Injury Association (ASIA) based on lesion type and affected motor and/or sensory function. Epidural hematomas are among the most common postsurgical complication; rarer complications include epidural abscesses, pseudomeningoceles, and cauda equina syndrome. Singh addresses spinal cord syndromes, mechanisms of injury, and specific insults to nerve roots that can result from spine surgery, including complications related to instrumentation. In assessing for possible postoperative injury, careful patient evaluation in the post-anesthesia care unit is essential. Although steroid therapy for management of acute spinal cord injuries is recommended according to specified guidelines, the use of corticosteroids (methylprednisolone) nevertheless remains controversial. This article also provides a discussion on the modalities of intraoperative monitoring, including somatosensory-evoked potentials, motor-evoked potentials, and stimulated electromyography, which can aid in the prevention of spinal cord and nerve root injuries.

    • Keywords:
    • acquired spondylolisthesis

    • anterior fusion

    • asymptomatic spondylolysis

    • decompression

    • degenerative spondylolisthesis

    • developmental spondylolisthesis

    • direct repair

    • dysplastic spondylolisthesis

    • fusion

    • Gaines procedure

    • high dysplastic spondylolisthesis

    • high-grade spondylolisthesis

    • in situ arthrodesis

    • in situ circumferential fusion

    • isthmic (spondylolytic) spondylolisthesis

    • L5 incidence angle

    • low dysplastic spondylolisthesis

    • low-grade spondylolisthesis

    • lumbosacral kyphosis

    • lytic defect

    • malformed L5-S1 articulation

    • Meyerding grading system

    • pathologic spondylolisthesis

    • pelvic incidence

    • pelvic tilt

    • postsurgical spondylolisthesis

    • posttraumatic spondylolisthesis

    • pseudarthrosis

    • reduction

    • sacral inclination

    • sacral slope

    • sagittal rotation

    • slip progression

    • spondylolisthesis in adolescents and children

    • spondylolysis in adolescents and children

    • spondyloptosis

    • symptomatic spondylolysis

    • Taillard method

    • traumatic spondylolisthesis

    • Wiltse approach

    • Subspecialty:
    • Spine