ACUTE SPONDYLOLYTIC SPONDYLOLISTHESIS - RISK OF PROGRESSION AND NEUROLOGICAL COMPLICATIONS

Acute spondylolytic spondylolisthesis was diagnosed after major trauma in five patients. The level of injury was between the third and fourt h lumbar vertebrae in one patient and between the fifth lumbar and fir st sacral vertebrae in four. The initial spondylolisthesis was grade I in four patients and grade III in one. Four of the patients were init ially managed nonoperatively. The deformity did not progress in a five -year-old boy with grade-I spondylolisthesis who had been managed with immobilization in a body cast. The deformity progressed in two of the adolescents who had been managed non-operatively; the progression was from grade I to grade III in one of these patients and from grade III to grade V (spondyloptosis) in the other, in whom a cauda equina synd rome also developed. The latter patient was subsequently managed with posterior reduction and arthrodesis followed by an anterior arthrodesi s, and the neurological deficits resolved. The deformity also progress ed, from grade I to grade II over three years, in a fifty-seven-year-o ld woman who had been managed nonoperatively. One patient who had a gr ade-I deformity was managed with immediate operative stabilization fol lowed by immobilization in a thoracolumbosacral orthosis; the deformit y did not progress. Although minor or repetitive trauma is often assoc iated with spondylolysis, high-energy trauma may produce a more severe form of spondylolysis with spondylolisthesis. These deformities are m ore unstable, with instability similar to that of a fracture-dislocati on, and they have a greater propensity to progress than the usual form of spondylolytic spondylolisthesis. Although children may be managed with immobilization in a cast, operative stabilization of this deformi ty in adolescents and adults may be necessary to prevent progression o f the spondylolisthesis and possible neurological compromise.