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Case No. 3: Degenerative Spondylolisthesis

Degenerative spondylolisthesis
Case No. 3: Degenerative Spondylolisthesis


CT lumbar spine (Sagittal view)

Description of Case No. 3:

Sagittal reformatted image derived from axial CT scans of the
lumbar spine shows degeneration at the L4/5, level with a
vacuum phenomenon. A grade II spondylolisthesis is seen at the
L4/5, level. L4/5, level disc spaces are narrowed.


Degenerative Spondylolisthesis

Key Points:

The most frequently seen alignment abnormality is spondylolisthesis, which is defined as ventral slippage of
a vertebra relative to the vertebra below.

Spondylolisthesis is most frequently seen at L5/S1,  level and to a lesser extent at L4/5, level.

A commonly used classification system defines spondylolisthesis as

  • Type I (dysplastic/congenital): secondary to an abnormal neural arch.
  • Type II (isthmic): secondary to the lesion of pars interarticularis.
  • Type III (degenerative): due to chronic instability and intersegmental degenerative changes.
  • Type IV (post-traumatic): fracture other than fracture of pars leading to slippage.
  • Type V (pathological): may be due to diffuse or local pathology.
  • Type VI (iatrogenic): due to unknown causes.

The two most common causes of spondylolisthesis relate to bilateral defects in the pars interarticularis (isthmic or spondylolytic spondylolisthesis) and facet disease (degenerative spondylolisthesis)

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