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Test 2 - Nrad

Spondylolisthesis

QuestionAnswer
***What is defined as the anterior displacement of a vertebral body in relationship to the segment immediately below? Spondylolisthesis (aka Anterolisthesis)
***What is defined as an interruption of the pars? Spondylolysis
***What is defined as posterior displacement of the vertebral body relative to the segment below? Retrolisthesis
***What is the most common stress fracture in the body? Pars fracture (spondylolysis)
***What is defined as anterior slippage of L5, where it is actually anterior and inferior to the sacral promontory? Spondyloptosis
In what type of individuals are incidences of spondylolysis seen most often? Athletes (diving, gymnsts, weightlifters, pole vaulting - all require repetitive hyperextension). High incidence in Alaskan Eskimo pop (up to 40%) and Native American pops.
***What is the most common location for spondylolisthesis and/or spondylolysis? L5 - 90%, L4 - 5%
FACT: There are 5 WILTSE Classification types of Spondylolisthesis: 1 - Dysplastic 2 - Isthmic 3 - Degenerative 4 - Traumatic 5 - Pathological
What classification type of spondylolisthesis has a pars fracture? type 2 - Isthmic
T/F Type 3 - Degenerative Spondylolisthesis has a pars fracture and is most common at L5. False - There is NO pars fracture and it is 10X more commonly seen at L4 level
T/F If you see a vaccum phenomenon (gas density) in a disc that is a sign of disc degeneration? true
***What classification of spondylolisthesis is most common at C2 and is referred as a Hangman's Fracture? Type 4 - Traumatic
What classification of spondylolisthesis is associated with Paget's disease, metastatic bone disease, and osteopetrosis? Type 5 - Pathological
T/F Approx. 50% of patients with spondylolisthesis and/or spondylolysis NEVER develop back pain? true, those that do experience back pain usually have a seperate biomechanical or pathological cause
Clincally, if a patient comes into your office and you hear a clicking sound during straight leg raise "spinal rattle" and the have a short strided gait, what could they have? Spondylolisthesis
Should you discourage an athlete to stop activities if they have a chronic process of spondylolisthesis? NO not for chronic procss, advise them to stop activity if they have Acute process of spondylolisthesis
At what age is progression of spondylolisthesis most common? 5 - 10 yoa, it is very uncommon past 18 yoa
***Radiographically what is it called when an advanced grade of 3, 4, or 5 spondylolisthesis is seen on a AP projection at L5? bowline of Brailford (aka: inverted Napolean's hat sign, or Gendarme's cap)
***What is Meyerdin'g Method? It is a line of mensuration to test for anterior displacement m/c at L5/S1. (It divides the Sacral Base into 4 quadrants).
What are the grades for Meyerding's Method? Grade 1 - 0-25% ant displacement 2. 25-50% ant displacement 3.51-75% ant dis 4.76-100% ant dis ***Grade 5 = SPONDYLOPTOSIS
What is the name for an anterior spondylophyte (osteophyte) formation at anterior aspect of sacral base and is an attempt to stabilize? Buttressing phenomenom
What type of radiographic view is used to see a defect in the pars? Oblique Lumbars, so you can see the broken neck of the little Scotty Dog
What is it called when there is a unilateral pars defect and contralateral sclerosing of the pedicle? Wilkinson Syndrome - this is the m/c cause of a sclerotic pedicle
T/F If you see a sclerotic pedicle on one side and a pars fracture on the other side its probably NOT metastatic disease? true
Normal Pedicle + Sclerotic Pedicle = Be concerned, (if there is a sclerotic pedicle and no pedicle on the other side, this is usually ok)
T/F Spondylolisthsis in the cervical spine are uncommon? true, if present m/c at C6
T/F In the cervical spine pars defects are m/c unilateral and approx. 50% are associated with SBO of a vertebrae? false, pars are m/c bilaterally but 50% are associated with a SBO
***Where is Spondylolytic Spondylolisthesis most commonly seen? L5
***Where is Degenerative spondylolisthesis most commonly seen? L4
Since it Is uncommon to see children with back pain, if one comes in your office with back pain what could this be a sign of? Pars Defect
If there is a greater of _____ mm of total translation in flexion and extension in a spondylolisthetic segment, it may be considered unstable? greater than 4mm in translation = unstable
How should you advise someone with spondylolysis to help treat their problem? Spondylolysis means - stop causative activity 6-8 wks, bed rest, stretching hamstrings and strengthing abdominal and back mm. Boston brace may help (this is different than spondylolisthesis when it depended if it was chronic or actue)
Created by: pcc Normal Rad