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.
[Show abstract][Hide abstract] ABSTRACT: A study of spondylolysis and spondylolisthesis in 142 children and adolescents is reported. In twelve of the seventy-nine patients followed for over a year the affected vertebra slipped further by 10 per cent or more. Increasing slip occurred mainly during the adolescent growth spurt, and was greater when spinal bifida or other vertebral anomalies were present. If at presentation the slip is less than 30 per cent then further slip beyond 30 per cent is unlikely. Decompression posteriorly is advised when signs of nerve pressure are present. Indications for spinal fusion are suggested; the intertransverse method of fusion was used in sixty-nine patients.
The Bone & Joint Journal 12/1977; 59-B(4):490-4. · 3.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Because the etiology of spondylolysis is not well understood, the authors performed an analysis of loads and stresses in human lumbar vertebrae to determine whether purely mechanical factors are likely to cause spondylolytic fractures in a normal spine. To perform these studies, modeling methods were applied. A mechanical system was developed to study muscle forces and reactions in joints of the lumbar spine. Next an optimization approach was applied to find loads on vertebrae and muscle forces. Finally photoelastic experiments were performed to find effective stresses and stress concentrations in low lumbar vertebrae. The analysis showed that the highest stresses appear in parts interarticularis. The results prove that factors of a purely mechanical nature are of fundamental importance in the etiology of spondylolysis.
[Show abstract][Hide abstract] ABSTRACT: We performed a prospective roentgenographic study to determine the incidence of spondylolysis, spondylolisthesis, or both, in 500 unselected first-grade children from 1955 through 1957. The families of the children with spondylolysis were followed in a similar manner. The incidence of spondylolysis at the age of six years was 4.4 per cent and increased to 6 per cent in adulthood. The degree of spondylolisthesis was as much as 28 per cent, and progression of the olisthesis was unusual. The data support the hypothesis that the spondylolytic defect is the result of a defect in the cartilaginous anlage of a vertebra. There is a hereditary pre-disposition to the defect and a strong association with spina bifida occulta. Progression of a slip was unlikely after adolescence and the slip was never symptomatic in the population that we studied.
The Journal of Bone and Joint Surgery 07/1984; 66(5):699-707. · 5.28 Impact Factor
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