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jsmc-10107


RISK FACTORS AND CONSERVATIVE MANAGEMENT OF SPONDYLOLYSIS AND SPONDYLOLISTHESIS GRADE I AND II



Ari Sami Hussain Nadhim a, b, Nabaz M. Mustafa b and Seerwan O. Hasan b 


a Department of Surgery, College of Medicine, University of Sulaimani.
b Shahid Dr. Aso Neurosurgical and Ophthalmological Hospital and Surgical Emergency Hospital in Sulaymaniyah city, Kurdistan region, Iraq.


Submitted: 27/7/2016; Accepted: 7/3/2017


ABSTRACT


Background

Spondylolysis is a fracture of pars interarticularis without slippage of the vertebral bodies. Spondylolisthesis is anterior slippage of one vertebral body on to the immediate inferior vertebral body. The conservative treatment of spondylolysis and low-grade spondylolisthesis is preferable initial step in the management.

Objectives 

The purposes were to find the risk factors for lumbar spondylolysis and spondylolisthesis and the plausibility of conservative management of them.

Materials and Methods

Prospective cohort study of a series of (100) patients performed. Each followed up for six consecutive months during 2012-2014. Failure of conservative treatment necessitated surgical intervention. Inclusion criteria for the patients to be included in the study were that the patient needed to be afflicted with Spondylolysis, and/or spondylolisthesis Meyerding grade I and II. We assessed the grades of slippage by Meyerding grading system

Results

Patients included in the study were 14% males and 86% females, and the mean and SD (Standard Deviation) age were (43.92±13.83) years. The Body Mass Index (BMI) of the patients were 55% overweight, and 17% obese, with a significant P-value of (<0.001). The mean±SD body height was (166.75±6.94 cm). There was history of trauma in 63% patients, and the level of pars fracture was L5 in 65%, L4 in 30%, and L3 in 4%. The degrees of vertebral slippage were 59% grade I, 34% spondylolysis, 7% grade II. Eleven (11%) of patients were indicated for surgery. Transpedicular screw fixation and fusion was performed for nine patients and two of them refused surgery.

Conclusion

Conservative treatment is preferable as an initial step in the management of spondylolysis and spondylolisthesis Grade I and II if there were no neurological deficits.

KEYWORDS

Meyerding grading; Spondylolisthesis; Spondylolysis.