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    Go to the top of the page   ID: 20040113153041 Original case in english  More links about this topic on Pubmed (PubMed Reader)
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    L5 Spondylolysis with Grade I L5/S1 Spondylolisthesis (Meyerding Classification)
    Carsten Bock, K Stock. L5 Spondylolysis with Grade I L5/S1 Spondylolisthesis (Meyerding Classification). PedRad [serial online] vol 4, no. 1.
    URL: www.PedRad.info/?search=20040113153041


     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] There are CT-images available for this case. [ CT ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Carsten Bock, K. Stock (Universität Halle)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    12 Years  

     
     Pediatric Radiology CasesGender:

    Female  

     
     Pediatric Radiology CasesRegion-Organ:

    Spinal canal / Myelon  

     
     Pediatric Radiology CasesMost likely etiology:

    physical  

     
     Pediatric Radiology CasesHistory:

    12 year-old girl, fall from the stairs on her back. Main pain is in the thoracolumbar junction, but also throughout the lumbar spine. For many years, the girl has taken part in ballet and has already been in orthopedic treatment for back pain.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    Spondylolisthesis arises as a result of a lysis on both sides of the pars interarticularis (isthmus) of the vetebral arch. In 70% of the cases, L5 is affected; followed by the overlying lumbar segments. In the cervical spine it is very rare (and then mostly at C6), in the thoracic spine it has never been described. There is no gender preference. Spondylolysis is the most common gap development of the vetebral arch in caucasians with a frequency of 4-5%. A genetic predisposition could not be proven. Therefore, a cause could be a congentitally related dysplasia of the isthmus. A solely traumatic or secondary cause (inflammation, tumor) is very rare and the assumption of a spondylolysis as a result of a stress fracture in growth is often discussed, but can only be proven in a very few cases. The overly-frequent combination with a medial arch gap (like in this case) rather points to a dysplastic cause.

    Grading of spondylolithesis (without consideration of the cause) according to Meyering (1931, 1932):
    Grade I - ventral gliding up to 1/4 of the vertebral AP diameter.
    Grade II - ventral gliding up to1/2 of the vertebral AP diameter.
    Grade III - ventral gliding up to 3/4 of the vertebral AP diameter.
    Grade IV - ventral gliding up to 4/4 (Spondyloptosis) of the sacral base in the lateral view.

    Higher stages of olisthesis were only seen at L5/S1.  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Lumbar spine, lateral view: slight ventral gliding of lumbar vertebral body 5 over the base of the sacrum. Noticeable distance of the vetebral body to the posterior vetebral arch of L5 as well as not completely identifiable lucent line in the base of the spinous process of L5.






    CT 1 <- view CT 1

    CT 1: (Bone Window): In the upper image, discontinuity of the pars interarticularis of both sides and wide spinal canal. In the lower image, gap in spinous process of S1.






    CT 2 <- view CT 2

    CT 2: (3D-Reconstruction): Obvious discontinuity of the isthmus on both sides with ventral gliding of the L5 vertebral body over S1.






    CT 3 <- view CT 3

    CT 3: (3D-Reconstruction): see CT 2, Posterior view.



     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    Expert's opinion  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    Acute fracture, stress fracture (ballet), secondary etiology (inflammation, tumorous).  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    Often, this is only an incidental finding (like in this case), since only about 25% of the affected patients complain about symptoms. These complaints are more often in patients who are heavily into sports or who heavily stress the back (i.e. Ballet), which may conclude a predisposition for back problems.

    The treatment is initally conservative; only in radicular symptoms, an indication to surgical stabilization with possible reposition is taken into consideration. Since the gliding process is usually finished in adolescence, a stabilization to inhibit a further displacement in adulthood is not indicated.  

     
     Pediatric Radiology CasesComments of the author about the case:

    N/A  

     
     Pediatric Radiology CasesFirst description / History:

    This was first described by Kilian in 1853. It is a compound word from the greek words "spondylos" (=vertebra) and "olisthesis" (= I glide).

    A spondylodesis over many segments was done for the first time by Hibbs in 1911.  

     
     Pediatric Radiology CasesLiterature:

    1. Medline: Medline
    Brossmann J., Czerny J., Freyschmidt J.:
    Grenzen des Normalen und Anfänge des Pathologischen in der Radiologie des kindlichen und erwachsenen Skeletts.
    Thieme 2001, 14. Aufl., S. 654-662.

    2. Medline: Medline
    Witt A. N., Rettig H., Schlegel F.:
    Orthopädie in Praxis und Klinik, Band V/Teil I
    Thieme 1980, S. 8.1-8.38.  

     
     Pediatric Radiology CasesKeywords:

    Spondylolisthesis, Spondylolysis, L5 spondylolysis, L5/S1 spondylolisthesis, grade I, Meyerding classification, child, childhood, pediatric radiology  

     
     Pediatric Radiology Cases Cite this article:

    Carsten Bock, K Stock. L5 Spondylolysis with Grade I L5/S1 Spondylolisthesis (Meyerding Classification). PedRad [serial online] vol 4, no. 1.
    URL: www.PedRad.info/?search=20040113153041  

     
     Pediatric Radiology Cases Read similar articles: with corresponding keywords
    in the same field: Spinal canal / Myelon
    or in the region: Spinal canal / Myelon
    or in the tissue/organ:
    or with the etiology: physical
     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] There are CT-images available for this case. [ CT ] View all modalities [ All ]   
     
    L5 Spondylolysis with Grade I L5/S1 Spondylolisthesis (Meyerding Classification)
    Carsten Bock, K Stock. L5 Spondylolysis with Grade I L5/S1 Spondylolisthesis (Meyerding Classification). PedRad [serial online] vol 4, no. 1.
    URL: www.PedRad.info/?search=20040113153041


     

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    L5 Spondylolysis with Grade I L5/S1 Spondylolisthesis (Meyerding Classification)
    Other cases by these authors:

    Search Carsten Bock in Medline Carsten Bock (9)   
    Search K. Stock in Medline K. Stock (4)   

    L5 Spondylolysis with Grade I L5/S1 Spondylolisthesis (Meyerding Classification)  
     
    L5 Spondylolysis with Grade I L5/S1 Spondylolisthesis (Meyerding Classification)
    Carsten Bock, K Stock. L5 Spondylolysis with Grade I L5/S1 Spondylolisthesis (Meyerding Classification). PedRad [serial online] vol 4, no. 1.
    URL: www.PedRad.info/?search=20040113153041


     

    Which diagnosis have other collegues guessed?


    • Spondylolisthesis
      Votes: 18 (94 %)


    • Osteosarcoma
      Votes: 0 (0 %)


    • Compression fracture
      Votes: 1 (5 %)


    • Fibrous dysplasia
      Votes: 0 (0 %)


    • Lateral arch closure maldevelopment
      Votes: 0 (0 %)



        Total answers: 19

     
    L5 Spondylolysis with Grade I L5/S1 Spondylolisthesis (Meyerding Classification)
    Carsten Bock, K Stock. L5 Spondylolysis with Grade I L5/S1 Spondylolisthesis (Meyerding Classification). PedRad [serial online] vol 4, no. 1.
    URL: www.PedRad.info/?search=20040113153041


     

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    L5 Spondylolysis with Grade I L5/S1 Spondylolisthesis (Meyerding Classification)
    Carsten Bock, K Stock. L5 Spondylolysis with Grade I L5/S1 Spondylolisthesis (Meyerding Classification). PedRad [serial online] vol 4, no. 1.
    URL: www.PedRad.info/?search=20040113153041


     




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