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synonyms:
Spondylosis ICD-9
- 738.4 (acquired spondylolisthesis or spondylolysis)
Spondylosis Etiology / Epidemiology / Natural History
- Spondylolysis = disruption of the pars interarticularis.
- Generally from cyclic loading of the inferior articualr facet onto the inferior lamina and pars interarticularis. May be genetic risk factors.
- Spondylolisthesis = anterior vertebral tanslation in relation to the caudal vertebra.
- Asymptomatic incidence: spondylolysis = 6%; spondylolisthesis = 3% (Belfi LM, Spine 2006;31:E907).
- Associated with football (lineman), gymnasts, ballet, figure skating, wrestlers, divers.
- Etiology: dysplastic, congenital, isthmic, degnerative, traumatic, patholigc.
- Risk factors: increasing age, obesity, lordotic angle, pelvic inclination (Sonne-Holm S, Eur Spine J 2007;16:821).
Spondylosis Anatomy
- L5-S1 slip affects L5 nerve roots.
Spondylosis Clinical Evaluation
- Low back pain aggravated by spine hyperextension. May have sciatic/radicular symptoms.
- Pain reproduced with back hyperextended while standing and performing a single leg hyperextension on the ipsilateral side of the lesion.
- Often have hip flexor and hamstring tightness.
- Crouched gait.
Spondylosis Xray / Diagnositc Tests
- A/P and Lateral views. Oblique views(30° ). Consider flexion/extension views. Xray findings (pars defect, vertebral slippage) do not correlate with clinical symptoms (Fredrickson BE, JBJS 1984;66A:699).
- SPECT(single photon emission computerized tomography) is most sensitive in detecting early spondylolysis.
- CT (3-mm reverse gantry): best defines lesion.
- MRI: reverse angle oblique axial T1 images and dual echo steady state images best demonstrate lesion. (Udeshi UL, Clin Radiol 1999;54:615).
Spondylosis Classification / Treatment
- Meyerding Grading
-Grade 1:0-15%
-Grade II; 26-50%
-Grade III; 51-75%
-Grade IV:76-100%
-Grade V: >100% (spondyloptosis)
- Lumbar corsets or rigid thoracolumbar braces. PT with abdominal strengthening, psoas and hamstring stretching. May consider electromagnetic stimulation for nonunions.
- Surgery: indicated for intractable pain with ADLs, spondylolisthesis >50%, progressive slippage, neurolic deficit. Surgical options include instrumented or noninstrumented posterolateral fusion, interbody fusion. Slip reduction has not demonstrated long-term clinical benefits verses insitu fusion. Consider vertebral resection for Grade V spondylolisthesis (Gaines RW, Spine 2005;30:S66).
- Surgical treatment for degenerative spondylolisthesis and associated spinal stenosis has shown improved outcomes compared to non-op treatment at 2 and 4 yrs post-op (Weinstein J, JBJS 2009;91:1295).
Spondylosis Associated Injuries / Differential Diagnosis
- Spina bifida occulta
- Tumor (malignancy/primary)
- Infection
- Facet arthrosis
Spondylosis Complications
Spondylosis Follow-up Care
- May return to sports when painfree with full ROM and strength.
- @12% of patients with bilateral pars defects and minor slippage will shown progression.
Spondylosis Review References
- Staendaert CJ, Br J Sports Med 2000;34:415
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