Isthmic (i.e. spondylolytic) spondylolisthesis is classically precipitated by progression of previous spondylolysis. Spondylolisthesis is typically categorized into isthmic and degerative spondylolisthesis. 2,3 Surgical treatment for spondylolisthesis should be considered it patients with persisting, debilitating symptoms that have not responded to conservative management. 3 While many patients respond to conservative management (NSAIDs, injections, bracing), many cases often require decompression, fusion, reduction, fixation, among other surgical interventions. 1,3,6 Grade IV and V spondylolisthesis indicates severe disc translation and is usually due to isthmic spondylolisthesis since significant damage to the pars interarticularis is generally required for impressive degrees of translation. The degree of Meyerding grading is generally associated with symptom severity. 1 The standard classification of spondylolisthesis is the Meyerding system (graded I through V), which correlates with the percentage of superior disc translocation over the inferior disc. 1,2,5 The presentation of spondylolisthesis can vary widely, including but not limited to compressive neurologic defects (i.e. spinal stenosis), mild-to-severe back pain, a cosmetic defect, and as an incidental finding. 1–4 While isthmic spondylolisthesis is the most common form of spondylolisthesis in children, degenerative spondylolisthesis predominates in adults, which can occur independent of pars interarticularis injury and has a tendency to present in female patients. Isthmic spondylolisthesis occurs when anterior displacement of the vertebra is caused by a defect in the pars interarticularis, commonly due to previous spondylolysis at the L5-S1 joint. This is a more serious condition as the instability has a possibility of a nerve compression.Spondylolisthesis is a broad term used to describe the anterior, lateral, or posterior slippage of one vertebral body over another. This is because the attachment to the posterior elements of the vertebra is defected. Spondylolysis often leads to spondylolisthesis – a forward slipping of the vertebral body. People often have tightness in the hamstring created by the body to guard the back. Activities involving hyperextension (excessive backward bending) exacerbates it. Symptoms of spondylolysis include back pain. It is more prevalent in some populations suggesting a hereditary component. Aging on the other hand causes loss of bone density which can lead to a stress fracture. This leads to increased stress and load on the spine. Obesity causes an increase in the natural curve of the lumbar spine, i.e. Obesity and ageing are two strongly associated factors with its incidence in the general population. While spondylolysis is much more common in youths, it can occur in the general population too. The spine is bent forward, bent back, and rotated many times in these sports. The various sports where this is a common occurrence are gymnastics, dance, tennis and cricket. This leads to an over training of certain biomechanics imposing repetitive stress. It is especially common in adolescents who engage in competitive sports. Spondylolysis affects 4-6% of the population. However it may occur at any of the other lumbar as well as thoracic vertebrae. It occurs most commonly at the fifth lumbar vertebrae, which is the last mobile segment in the spinal column. It is small is a weak link in the vertebrae that, It has been proposed that this region is particularly vulnerable when the spine is in an extended position and force suddenly compresses through the spinal column, such as landing on the foot after a hop. High amounts of compressive load is often exerted in the area. The pars interarticularis also called the pars in an obscure area of the vertebra in the region of the facet. Vertebrae makes up the spinal column, and interposing discs are mounted atop each other. Spondylolysis is an overuse injury in which there is a repeated stress to an area of the vertebral column called the pars.
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