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Spondylolysis
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Isthmic spondylolysis (IS)
              • Definitions

                • Unilateral or bilateral defects in pars interarticularis (PI) thought to result from repetitive stress injury
                  • Pars is junction of pedicle, lamina, and facet

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Nonvascular Interventions

                        • Nuclear Medicine Findings

                          • Imaging Recommendations

                            DIFFERENTIAL DIAGNOSIS

                              PATHOLOGY

                              • General Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Borg B et al: Pedicle marrow signal hyperintensity on short tau inversion recovery- and t2-weighted images: prevalence and relationship to clinical symptoms. AJNR Am J Neuroradiol. 32(9):1624-31, 2011
                                              2. Lee JY et al: Surgeons agree to disagree on surgical options for degenerative conditions of the cervical and lumbar spine. Spine (Phila Pa 1976). 36(3):E203-12, 2011
                                              3. Leone A et al: Lumbar spondylolysis: a review. Skeletal Radiol. Epub ahead of print, 2010
                                              4. Lastfogel JF et al: Sacral fractures following stand-alone L5-S1 anterior lumbar interbody fusion for isthmic spondylolisthesis. J Neurosurg Spine. 13(2):288-93, 2010
                                              5. Baek OK et al: Extraforaminal lumbar interbody fusion for the treatment of isthmic spondylolisthesis. J Spinal Disord Tech. 22(3):219-27, 2009
                                              6. Sakai T et al: Significance of magnetic resonance imaging signal change in the pedicle in the management of pediatric lumbar spondylolysis. Spine (Phila Pa 1976). 35(14):E641-5, 2010
                                              7. Ekman P et al: Predictive factors for the outcome of fusion in adult isthmic spondylolisthesis. Spine (Phila Pa 1976). 34(11):1204-10, 2009
                                              8. Don AS et al: Facet joint orientation in spondylolysis and isthmic spondylolisthesis. J Spinal Disord Tech. 21(2):112-5, 2008
                                              9. Park P et al: Minimally invasive transforaminal lumbar interbody fusion with reduction of spondylolisthesis: technique and outcomes after a minimum of 2 years' follow-up. Neurosurg Focus. 25(2):E16, 2008
                                              10. McTimoney CA et al: Current evaluation and management of spondylolysis and spondylolisthesis. Curr Sports Med Rep. 2(1):41-6, 2003
                                              11. Merbs CF: Asymmetrical spondylolysis. Am J Phys Anthropol. 119(2):156-74, 2002
                                              12. Logroscino G et al: Spondylolysis and spondylolisthesis in the pediatric and adolescent population. Childs Nerv Syst. 17(11):644-55, 2001
                                              13. Standaert CJ et al: Spondylolysis. Phys Med Rehabil Clin N Am. 11(4):785-803, 2000
                                              14. Saifuddin A et al: The value of lumbar spine MRI in the assessment of the pars interarticularis. Clin Radiol. 52(9):666-71, 1997
                                              15. Ulmer JL et al: MR imaging of lumbar spondylolysis: the importance of ancillary observations. AJR Am J Roentgenol. 169(1):233-9, 1997
                                              16. Ohmori K et al: Vertebral slip in lumbar spondylolysis and spondylolisthesis. Long-term follow-up of 22 adult patients. J Bone Joint Surg Br. 77(5):771-3, 1995
                                              17. Ulmer JL et al: Distinction between degenerative and isthmic spondylolisthesis on sagittal MR images: importance of increased anteroposterior diameter of the spinal canal ("wide canal sign"). AJR Am J Roentgenol. 163(2):411-6, 1994
                                              18. Jinkins JR et al: Spondylolysis, spondylolisthesis, and associated nerve root entrapment in the lumbosacral spine: MR evaluation. AJR Am J Roentgenol. 159(4):799-803, 1992
                                              19. Reynolds R: Spondylolysis and Spondylolisthesis. Seminars in Spine Surgery. 4:235-47, 1992
                                              20. Danielson BI et al: Radiologic progression of isthmic lumbar spondylolisthesis in young patients. Spine. 16(4):422-5, 1991
                                              21. Frennered AK et al: Natural history of symptomatic isthmic low-grade spondylolisthesis in children and adolescents: a seven-year follow-up study. J Pediatr Orthop. 11(2):209-13, 1991
                                              22. Rossi F et al: Lumbar spondylolysis: occurrence in competitive athletes. Updated achievements in a series of 390 cases. J Sports Med Phys Fitness. 30(4):450-2, 1990
                                              23. Johnson DW et al: MR imaging of the pars interarticularis. AJR Am J Roentgenol. 152(2):327-32, 1989
                                              24. Rossi F: Spondylolysis, spondylolisthesis and sports. J Sports Med Phys Fitness. 18(4):317-40, 1978
                                              25. Wiltse LL et al: Classification of spondylolisis and spondylolisthesis. Clin Orthop. (117):23-9, 1976
                                              26. Wiltse LL: Spondylolisthesis. West J Med. 122(2):152-3, 1975
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        • Diagnostic Checklist

                                                          TERMINOLOGY

                                                          • Synonyms

                                                            • Isthmic spondylolysis (IS)
                                                          • Definitions

                                                            • Unilateral or bilateral defects in pars interarticularis (PI) thought to result from repetitive stress injury
                                                              • Pars is junction of pedicle, lamina, and facet

                                                          IMAGING

                                                          • General Features

                                                            • Radiographic Findings

                                                              • CT Findings

                                                                • MR Findings

                                                                  • Nonvascular Interventions

                                                                    • Nuclear Medicine Findings

                                                                      • Imaging Recommendations

                                                                        DIFFERENTIAL DIAGNOSIS

                                                                          PATHOLOGY

                                                                          • General Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Borg B et al: Pedicle marrow signal hyperintensity on short tau inversion recovery- and t2-weighted images: prevalence and relationship to clinical symptoms. AJNR Am J Neuroradiol. 32(9):1624-31, 2011
                                                                                          2. Lee JY et al: Surgeons agree to disagree on surgical options for degenerative conditions of the cervical and lumbar spine. Spine (Phila Pa 1976). 36(3):E203-12, 2011
                                                                                          3. Leone A et al: Lumbar spondylolysis: a review. Skeletal Radiol. Epub ahead of print, 2010
                                                                                          4. Lastfogel JF et al: Sacral fractures following stand-alone L5-S1 anterior lumbar interbody fusion for isthmic spondylolisthesis. J Neurosurg Spine. 13(2):288-93, 2010
                                                                                          5. Baek OK et al: Extraforaminal lumbar interbody fusion for the treatment of isthmic spondylolisthesis. J Spinal Disord Tech. 22(3):219-27, 2009
                                                                                          6. Sakai T et al: Significance of magnetic resonance imaging signal change in the pedicle in the management of pediatric lumbar spondylolysis. Spine (Phila Pa 1976). 35(14):E641-5, 2010
                                                                                          7. Ekman P et al: Predictive factors for the outcome of fusion in adult isthmic spondylolisthesis. Spine (Phila Pa 1976). 34(11):1204-10, 2009
                                                                                          8. Don AS et al: Facet joint orientation in spondylolysis and isthmic spondylolisthesis. J Spinal Disord Tech. 21(2):112-5, 2008
                                                                                          9. Park P et al: Minimally invasive transforaminal lumbar interbody fusion with reduction of spondylolisthesis: technique and outcomes after a minimum of 2 years' follow-up. Neurosurg Focus. 25(2):E16, 2008
                                                                                          10. McTimoney CA et al: Current evaluation and management of spondylolysis and spondylolisthesis. Curr Sports Med Rep. 2(1):41-6, 2003
                                                                                          11. Merbs CF: Asymmetrical spondylolysis. Am J Phys Anthropol. 119(2):156-74, 2002
                                                                                          12. Logroscino G et al: Spondylolysis and spondylolisthesis in the pediatric and adolescent population. Childs Nerv Syst. 17(11):644-55, 2001
                                                                                          13. Standaert CJ et al: Spondylolysis. Phys Med Rehabil Clin N Am. 11(4):785-803, 2000
                                                                                          14. Saifuddin A et al: The value of lumbar spine MRI in the assessment of the pars interarticularis. Clin Radiol. 52(9):666-71, 1997
                                                                                          15. Ulmer JL et al: MR imaging of lumbar spondylolysis: the importance of ancillary observations. AJR Am J Roentgenol. 169(1):233-9, 1997
                                                                                          16. Ohmori K et al: Vertebral slip in lumbar spondylolysis and spondylolisthesis. Long-term follow-up of 22 adult patients. J Bone Joint Surg Br. 77(5):771-3, 1995
                                                                                          17. Ulmer JL et al: Distinction between degenerative and isthmic spondylolisthesis on sagittal MR images: importance of increased anteroposterior diameter of the spinal canal ("wide canal sign"). AJR Am J Roentgenol. 163(2):411-6, 1994
                                                                                          18. Jinkins JR et al: Spondylolysis, spondylolisthesis, and associated nerve root entrapment in the lumbosacral spine: MR evaluation. AJR Am J Roentgenol. 159(4):799-803, 1992
                                                                                          19. Reynolds R: Spondylolysis and Spondylolisthesis. Seminars in Spine Surgery. 4:235-47, 1992
                                                                                          20. Danielson BI et al: Radiologic progression of isthmic lumbar spondylolisthesis in young patients. Spine. 16(4):422-5, 1991
                                                                                          21. Frennered AK et al: Natural history of symptomatic isthmic low-grade spondylolisthesis in children and adolescents: a seven-year follow-up study. J Pediatr Orthop. 11(2):209-13, 1991
                                                                                          22. Rossi F et al: Lumbar spondylolysis: occurrence in competitive athletes. Updated achievements in a series of 390 cases. J Sports Med Phys Fitness. 30(4):450-2, 1990
                                                                                          23. Johnson DW et al: MR imaging of the pars interarticularis. AJR Am J Roentgenol. 152(2):327-32, 1989
                                                                                          24. Rossi F: Spondylolysis, spondylolisthesis and sports. J Sports Med Phys Fitness. 18(4):317-40, 1978
                                                                                          25. Wiltse LL et al: Classification of spondylolisis and spondylolisthesis. Clin Orthop. (117):23-9, 1976
                                                                                          26. Wiltse LL: Spondylolisthesis. West J Med. 122(2):152-3, 1975