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Spondylolysis and Spondylolisthesis


KEY FACTS

Terminology

  • Spondylolysis: Defect/break in pars interarticularis

  • Spondylolisthesis: Spondylolysis + anterior slippage of vertebra in relation to vertebra below

Imaging

  • Radiographs (insensitive): Break in neck of “Scotty dog” (pars interarticularis defect on oblique standing views of lumbar spine)

  • Bone CT

    • Linear lucency or defect in pars interarticularis

      • –

        Sagittal or oblique sagittal reformatted imaging vital in assessment

    • Incomplete ring sign on axial imaging ± distraction

    • Spondylolisthesis & foraminal narrowing on sagittal reformatted images

    • Secondary finding of sclerosis &/or hypertrophy of contralateral pedicle & lamina

  • SPECT bone scan imaging helpful for diagnosis

    • Intense focal uptake in posterior elements, unilateral or bilateral

    • Remote or healed may be occult (normal)

  • SPECT/CT: Confirms diagnosis with anatomy & physiology

  • MR: ↑ conspicuity of marrow & soft tissue edema with fat suppressed fluid-sensitive techniques

Pathology

  • Repetitive microtrauma results in stress fracture

    • Participation in gymnastics, weightlifting, wrestling, cricket, & American football at young age

    • L5 affected in 85%, L4 in 5-15%

Clinical Issues

  • Asymptomatic (80%); back pain (exacerbated by rigorous activities), back spasms, &/or radiating pain

  • 40% incidence in children with lower back pain

  • Therapy mainly conservative; surgical if conservative treatment fails or subluxation progresses

Lateral graphic shows a defect within the pars interarticularis (spondylolysis) at L5
. Notice the resultant anterior slippage (spondylolisthesis) of L5 on S1.

Axial NECT in a 14-year-old girl who presents with severe left flank pain for a renal stone evaluation shows an incomplete ring with bilateral distracted pars interarticularis defects
(spondylolysis) at L5.

Coronal SPECT bone scan in a 15 year old who presents with lower back pain shows asymmetric uptake
in the posterior elements of L5, right > left. NECT images (not shown) demonstrated right L5 spondylolysis with reactive stress changes at the left L5 pars interarticularis.

Sagittal STIR MR in 14 year old with back pain shows a pars defect
with edema in the marrow of the posterior elements & adjacent soft tissues. STIR images can be helpful in detecting marrow edema associated with spondylolysis.

IMAGING

General Features

  • Location

    • L5: 85%; L4: 5-15%

    • Cervical spine usually congenital

    • 10-15% unilateral

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