It’s not a “Slipped” Disc… (Part 2 of 3)

A few weeks ago, we discussed what a spondylolisthesis is by definition. This week, we are going to touch on the different causes.

Spondylolisthesis is classified using the Wiltse Classification, which consists of 6 different types:

- Type I: Dysplastic – caused by a congenital defect

- Type II: Isthmic – defect of the pars interarticularis

- Type III: Degenerative – arthritis

- Type IV: Traumatic – trauma or injury to the vertebrae

- Type V: Pathologic – caused by structural weakness of the bone, other primary disease

- Type VI: Iatrogenic – adverse reaction to medical intervention

The rarest type is dysplastic, which is a defect in the development and formation of the facet. The most common type is isthmic, which is a defect of the pars interarticularis. This is usual a result of repetitive stress, typically repeated hyperextension, causing a jamming of the facet joints. Essentially resulting in a stress fracture, leading to decreased stability of the vertebrae. It is often seen in female gymnasts.

It is possible to prevent an isthmic spondylolisthesis if caught early enough. Prior to a defect in the pars interarticularis happening, “pending spondylolysis” can be visualized via MRI. This is seen on a STIR MRI, in which edema can be seen in the pars, indicating a stress fracture. This is usually corrected by utilizing a Boston Overlap Brace, which keeps the patient in an anti-lordotic posture to avoid further stress placed on the pars. It is typically worn for 3 months.

There are alternative methods of stabilizing the spine and minimizing stress on the vertebrae. We will discuss some of those methods in the next part of the series.

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