Spondylolisthesis

Spondylolisthesis treatment prices in Germany are normally 75% below the cost for surgical treatment the affects of Spondylolisthesis in the US and are individually quoted. They include all medical expenses, the hospital stay, surgeon's fees, operation room fees, anesthesia, anesthesiologist's fees, medicine, nursing, semi-private room, meals, pre-op diagnosis, local phone and English TV.

Spondylolisthesis describes the displacement of a vertebrae or the vertebral column in relation to the vertebrae below. The term "Spondylolisthesis" was coined in 1854, from the Greek "spondylo" for vertebrae and "olisthesis" for slip. These "slips" occur most commonly in the lumbar spine. A "hangman's fracture" is a specific type of Spondylolisthesis where the C1 vertebra is displaced anteriorly relative to the C2 vertebra due to fractures of the C2 vertebra's pedicles.

Spondylolisis is the most common cause of spondylolisthesis. The hereditary factor mentioned above is quite notable, since the frequency of spondylolisthesis in Eskimos is 30 to 50 percent.

Spondylothesis is officially categorized into five different typed by the Wiltse classification system: Dysplastic, Isthmic, Degenerative, Traumatic, and Pathologic.

Dysplastic Spondylolisthesis is a true congenital Spondylothesis that occurs because of malformation of the lumbosacral junction with small, incompetent facet joints. Dysplastic spondylolisthesis is very rare, but tends to progress rapidly, and is often associated with more severe neurological deficits. It is difficult to treat, because the posterior elements and transverse processes tend to be poorly developed.

Isthmic Spondylolisthesis is the most common form of Spondylolisthesis. Isthmic Spondylolisthesis (also called spondylolytic Spondylolisthesis) is a common condition with a reported prevalence of 5%-7% in the U.S. population. Fredrickson, et al demonstrated that the spondylolytic defect is usually acquired between the ages of 6 and 16 years, and that the slip often occurs shortly there after. Once the slip has occurred, it rarely continues to progress, although one study did find an association between disc desiccation and slip progression during middle-age. It is thought that the vast majority of isthmic slips do not become symptomatic, but the incidence of symptoms is unknown. One very long-term prospective study by Fredrickson, et al that followed a cohort of 22 patients from the development of their slip into middle-age, reported that many of the patients experienced occasional back pain, but so does the vast majority of people without isthmic Spondylolisthesis.

The most common grading system for Spondylolisthesis is the Meyerding grading system for severity of slip. The system categorizes severity based upon measurements on lateral X-ray of the distance from the posterior edge of the superior vertebral body to the posterior edge of the adjacent inferior vertebral body. This distance is then reported as a percentage of the total superior vertebral body length:

  • Grade 1 is 0-25%
  • Grade 2 is 25-50%
  • Grade 3 is 50-75%
  • Grade 4 is 75-100%
  • Over 100% is Spondyloptosis, when the vertabra completely falls off the supporting vertabra.

Degenerative Spondylolisthesis is a disease of the older adult that develops as a result facet arthritis and facet remodeling. As the facets remodel, they take on a more sagittal orientation, allowing a mild slip to occur. These slips are very common, a study of osteoporosis found a 30 percent incidence among Caucasian women older than 65 years and a 60 percent incidence among African-American women older than 65 years. Most slips are asymptomatic, but can worsen the symptoms of neurogenic claudication when associated with lumbar spinal stenosis. Degenerative Spondylolisthesis with spinal stenosis is one of the most common indications for spine surgery among older adults and current evidence suggests that patients have much better success rates and more clinical benefit with decompression and artificial disc replacement surgery than decompression alone.

Traumatic Spondylolisthesis is very rare and may be associated with acute fracture of the inferior facets or pars interarticularis. It is treated in the same manner as other spinal fractures and there are only a handful of case reports on this type.

Pathologic Spondylolisthesis is the last type and is also very rare. This type can occur following damage to the posterior elements from metastases or metabolic bone disease. These slips have been reported in cases of Paget's disease of bone, tuberculosis, giant-cell tumors, and tumor metastases.