Isthmic spondylolisthesis in a nonambulatory patient: A case report

University of Wisconsin Hospital, Madison, WI, USA.
Spine (Impact Factor: 2.3). 12/2007; 32(24):E723-4. DOI: 10.1097/BRS.0b013e31815a59b7
Source: PubMed


Case report.
We present a case of a nonambulatory patient with an isthmic spondylolisthesis.
Pars defects are thought to be due to repeated mechanical stress on the spine in individuals with bipedal posture. Epidemiologic and mechanical studies have supported the idea that repeated lumbar flexion and extension can lead to stress fractures of the pars interarticularis and subsequent spondylolisthesis. There are no documented cases of isolated pars defects in nonambulatory patients. We present a case report of an isolated isthmic spondylolisthesis in a patient who has never ambulated.
Discussion of the patient's clinical and radiologic history with a brief review of the relevant background literature.
A pars interarticularis lesion was identified on plain radiographs in a 17-year-old girl with mixed spastic-athetoid cerebral palsy who never ambulated.
Although ambulatory individuals who engage in activities with repeated lumbar flexion have an increased risk of isthmic spondylolisthesis, this condition can occur in those who do not walk as well. This case illustrated that, although repetitive stress on an upright spine can increase an individual's propensity to develop a pars interarticularis defect, bipedal posture is not an absolute requirement for the development of this lesion.

1 Read
  • [Show abstract] [Hide abstract]
    ABSTRACT: Lumbar spondylolisthesis can lead to disabling low back pain and neurological deficits. This review details the clinical history, neurological examination, clinical presentation, imaging modalities, and current management standards for lumbar spondylolisthesis. Based on the available clinical trials, there is evidence that, compared with nonsurgical care, the surgical treatment of symptomatic spondylolisthesis offers a significant clinical benefit in the presence of progressive neurological deficits; cauda equina syndrome; failure of an adequate response to conservative therapy: radiographic instability with neurological symptoms; radiographic progression of subluxation to greater than grade II; symptomatic grades III, II, or spondyloptosis; and unremitting pain that affects the quality of life. Optimizing the diagnostic paths and surgical indications and standardizing both the surgical procedures as well as the outcome measurements with validated instruments should assist the spine care community in acquiring data that are essential for providing the best evidence-based treatment while reducing or eliminating procedures that lack evidence of either efficacy or value.
    Journal of neurosurgical sciences 06/2013; 57(2):103-13. · 1.16 Impact Factor