Spondylolisthesis Pathology

There are five main types of spondylolisthesis that have distinct causes and associated pathologies. These include:

  • Isthmic spondylolisthesis
  • Degenerative spondylolisthesis
  • Traumatic spondylolisthesis
  • Pathologic spondylolisthesis
  • Congenital spondylolisthesis

Image Credit: staras / Shutterstock.com

Dysplastic spondylolisthesis

Some individuals are born with increased susceptibility to spondylolisthesis as a result of rare congenital factors for this condition. This arises as a result of a malformation of the lumbosacral junction, which causes the facet joints to be smaller and less strong than normal.

Dysplastic spondylolisthesis is a rare condition that tends to progress rapidly with severe symptoms presenting in a relatively short timeframe. It can also be difficult to treat this condition due to the poor development of the posterior elements, which do not provide much surface area to carry out a fusion surgical procedure.

Isthmic spondylolisthesis

The most common type of spondylolisthesis is isthmic or spondylolytic spondylolisthesis. This condition usually occurs following a slip or fracture of the intravertebral joint acquired in childhood or adolescence, usually between the age of 6 and 16. The symptoms of the condition, however, do not become evident until some time later, typically in adulthood.

The severity of the isthmic slip can vary significantly and is categorized into three subtypes:

  • Pars fatigue fracture
  • Pars elongation
  • Pars acute fracture

Approximately 9 out of 10 patients with an isthmic slip are classified as low-grade with less than 50% slip, with the minority of patients exhibiting a high-grade slip.

Degenerative spondylolisthesis

Degenerative spondylolisthesis affects older adults and occurs as a result of facet arthritis and remodeling of the facets. The resulting weakness in the area can lead to movement and slipping of the spinal vertebrae, as well as the pathogenesis of spondylolisthesis.

This type of spondylolisthesis is relatively common, particularly among older individuals. Women older than 50 years are most likely to be affected by degenerative spondylolisthesis, with African-American individuals being more likely to be affected than Caucasian counterparts.

Degenerative Spondylolisthesis - Patient Animation

Traumatic spondylolisthesis

Traumatic spondylolisthesis is a rare form of the condition that arises as a result of acute fractures of the neural arch of the spine, which is distinct from the pars. The treatment for this form of the condition is very similar to that for other fractures of the spine. However, traumatic spondylolisthesis is rare and there is little research on the subject.

Pathologic spondylolisthesis

Pathologic spondylolisthesis is a rare type of spondylolisthesis that occurs due to damage to the posterior elements of the spine that may arise from a variety of causes. These include:

  • Paget’s disease of the bone
  • Tuberculosis
  • Giant-cell tumors
  • Tumor metastases

Conclusion

Although there are various causes for the vertebral slipping that is associated with spondylolisthesis, each of the types is associated with distinct symptoms as a result of the slipping of the vertebra. The treatment for any type of spondylolisthesis varies greatly according to the severity of the condition and the specific health factors of the patient that may affect the outcomes.

References

Further Reading

Last Updated: May 19, 2021

Susan Chow

Written by

Susan Chow

Susan holds a Ph.D in cell and molecular biology from Dartmouth College in the United States and is also a certified editor in the life sciences (ELS). She worked in a diabetes research lab for many years before becoming a medical and scientific writer. Susan loves to write about all aspects of science and medicine but is particularly passionate about sharing advances in cancer therapies. Outside of work, Susan enjoys reading, spending time at the lake, and watching her sons play sports.

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