Pediatric Spondylolisthesis, Spondylolysis

• generally agreed that spondylolysis or spondylolisthesis is an acquired pseudoarthrosis after a fatigue fracture, in patients who have a hereditary predisposition.
• slip progression occurs in 5% of pts, is more common in girls and is rare after skeletal maturity.

Spondylolisthesis Treatment

• Most patients with spondylolysis or grade 1 spondylolisthesis do not need surgical treatment
• pts who have persistent pain unresponsive to conservative measures, consider Posterolateral arthrodesis of two or more vertebrae or direct repair of the defect by bone grafting and internal fixation 
• Grade IV: generally treated with posterior spinal fusion with or without instrumentation
• Grade V: Spondylo-optosis, consider vertebrectomy

Spondylolisthesis References

• Pedersen AK, Hagen R: Spondylolysis and spondylolisthesis: Treatment by internal fixation and bone grafting of the defect. J Bone Joint Surg Am 1988;70:15-24.
• Lenke LG, ICL 2003;52:525.