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Spondylolisthesis
Spondylolisthesis
Spondylolisthesis
Spondylolisthesis
Definition
The term "Spondylolisthesis" refers to a condition where
one of the vertebrae (usually L5) becomes misaligned
anteriorly (slips forward) in relation to the vertebra below.
This forward slippage is caused by a problem or defect
within the pars interarticularis. Occasionally, facet joint
and/or posterior neural arch defects may also cause this
syndrome as well.
SUB-TYPE A:
Is the most commonly found type of
spondylolisthesis in people under 50 years
of age.
It is believed that "biomechanical stress,"
such as repetitive mechanical strain from
heavy work or sports, causes a fatigue
fracture within the pars interarticularis.
Isthmic spondylolisthesis
SUB-TYPE B:
• This type of Isthmic spondylolisthesis is characterized by a
elongated pars without separation.
• It is believed that the elongation occurs secondary to "repeated,
minor trabecular stress fractures of the pars." Each time these
possible sub-acute stress fractures occur and heal, the vertebral
body is displaced farther and farther forward. Eventually, the
pars may fail to heal and result as a full pars defect.
SUB-TYPE C:
These types of spondylolisthesis' are extremely rare and result
from an acute pars fracture, often as result of traumatic lumbar
hyperextension injury
DEGENERATIVE SPONDYLOLISTHESIS
• MRI of the lumbar spine can easily identify acute stress reactions
in the pars interarticularis. However, direct identification of pars
defects (old stress) may be slightly more difficult with MRI than
with CT.
• BONE SCAN : easily identifies acute stress reaction in the pars
interarticularis, but cannot identify old pars defect.
Treatment
o If the slip is small and the symptoms are
manageable, then treatment is most often with
observation. In children, this may include activity
restrictions, such as withholding the child from
participation in some sports.
Klippel-Feil syndrome
Torticollis
Definition
Is a condition in which
the head is tilted
toward one side, and
the chin is elevated
and turned toward the
opposite side.
Types of torticollis
Infantile torticollis
Acquired torticollis
Infantile torticollis
• causes:
Birth trauma or intrauterine malposition
• It is caused by a failure in
the normal segmentation
or division of the cervical
vertebrae during the early
weeks of fetal
development.
Klippel-Feil syndrome