Current Concept on the Classification and Treatment of Spondylolisthesis

Jae Chul Lee; Byung-Joon Shin

doi:10.4184/JKSS.2010.17.1.38

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Lee and Shin: Current Concept on the Classification and Treatment of Spondylolisthesis

Review Article

J Korean Soc Spine Surg 2010;17(1):38-48.

Published online: 18 March 2010

DOI: https://doi.org/10.4184/JKSS.2010.17.1.38

Current Concept on the Classification and Treatment of Spondylolisthesis

Jae Chul Lee, M.D., Byung-Joon Shin, M.D.

Department of Orthopaedic Surgery, Soonchunhyang University College of Medicine, Seoul, Korea

Corresponding auther: Byung-Joon Shin, M.D. Department of Orthopaedic Surgery, Soonchunhyang University College of Medicine, 657 Hannam-dong, Yongsan-gu, Seoul, Korea TEL: 82-2-709-9056, FAX : 82-2-794-9414 E-mail: schsbj@hosp.sch.ac.kr

Received 10 March 2010 Accepted 16 March 2010

“This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.”

Abstract

Study Design

A review of literature including classification and treatment of spondylolisthesis

Objectives

To review and discuss the classification and management of spondylolisthesis

Summary of Literature Review

Spondylolisthesis is one of the common spinal disorders that can create significant problems for the patients and spine surgeons, but there have been confusion of natural history and treatment strategies. It can be attributed to the absence of etiology-based classification system for individual patient prognosis and treatment decision.

Materials and Methods

Review of literature

Results

Marchetti and Bartolozzi have developed an etiology-based classification which has two main categories; developmental and acquired. These two types of spondylolisthesis seem to have significantly different natural histories and each of them needs different strategies for treatment.

Conclusions

Authors recommend using Marchetti and Bartolozzi classification system for spondylolisthesis patients.

Keywords: Lumbar spine, Spondylolisthesis, Classification, Treatment

REFERENCES

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Fig. 1.

Comparison of Marchetti-Bartolozzi's classification with Wiltse's.

Fig. 2.

Stress concentration on the pars during flexion and extension

Fig. 3.

MRI sagittal view of high dysplastic spondylolisthesis in a 16-year-old girl. Note the trapezoidal L5 and rounding of S1 upper end plate

Fig. 4.

Lateral view of low dysplastic spondylolisthesis in adult

Fig. 5.

Low dysplastic spondylolisthesis in 42-year-old man. Note the spur formation on the anterior aspect of S1.

Fig. 6.

Postsurgical spondylolisthesis. A 62-year-old woman had laminectomy on L4-5 2 years ago. Spondylolisthesis of L4 on L5 has been developed. Pre-laminectomy (A, B) and follow-up (C, D) AP and lateral views.

Fig. 7.

Low dysplastic spondylolisthesis in 66-year-old man. Note marked narrowing of disc space with foraminal stenosis at L4-5 level.

Fig. 8.

Measurement of slip by Meyerding scale (A) and Taillard grading (B)

Fig. 9.

Slip angle is important only for high dysplastic spondylolisthesis

Fig. 10.

Lumbar index=(A/B)×100

Table 1.

Wiltse classification

Type	Description
I	Dysplastic
II	Isthmic - defect in the pars interarticularis
IIA	lytic - fatigue fracture of the pars region
IIB	elongated but intact pars acute fracture
IIC	acute fracture
III	Degenerative - resulting from long standing intersegmental instability
IV	Posttraumatic - acute fractures in the posterior elements beside the pars region
V	Pathologic - destruction of the posterior elements form generalized of localized bone
VII	Postsurgical

Table 2.

Marchetti and Bartolozzi classification

Type (1994)
Developmental	High dysplastic	With lysis
		With elongation
	Low dysplastic	With lysis
		With elongation
Acquired	Traumatic	Acute fracture
		Stress fracture
	Postsurgical	Direct surgery
		Indirect surgery
	Pathologic	Local pathology
		Systemic pathology
	Degenerative	Primary
		Secondary

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