Carsten Bock, K. Stock (Universität Halle)  

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12 Years  

Female  

Spinal canal / Myelon  

physical  

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.  

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.  

<- 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.






<- 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.






<- 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.






<- view CT 3

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



 

Expert's opinion  

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

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.  

N/A  

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.  

1. 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:
Witt A. N., Rettig H., Schlegel F.:
Orthopädie in Praxis und Klinik, Band V/Teil I
Thieme 1980, S. 8.1-8.38.  

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

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