TREATMENT OF SPONDYLOLYSIS AND SPONDYLOLISTHESIS IN CHILDREN AND ADOLESCENTS

The treatment of spondylolysis and spondylolisthesis in children depen ds on the severity of clinical symptoms, pathologic anatomy, and progn osis, Simple spondylolysis can be cured by immobilization alone in sel ected cases, or by surgery when it remains symptomatic and resistant t o nonoperative treatment, The majority of cases are asymptomatic and r equire no treatment, Spondylolisthesis is classified into 2 types base d on the magnitude of the lumbosacral angle: spondylolisthesis with a horizontal sacrum (lumbosacral angle greater than or equal to 100 degr ees), which seldom requires surgical treatment, usually responds to or thotic management, and generally shows little progression; spondylolis thesis with a vertical sacrum (lumbosacral angle < 100 degrees) which is always progressive, can produce neurologic impairment and cosmetic and functional disability, and requires surgical treatment, In 17 case s the author has reduced the latter deformity by gradual traction in h yperextension followed by cast immobilization, then stabilized the red uction by posterolateral fusion performed through the cast without ins trumentation and without opening the spinal canal, When the lumbosacra l angle is not improved to 100 degrees or more by hyperextension and t raction, an anterior console interbody fusion is added before the post erolateral fusion.