Spondylolisthesis

Upper Chesapeake Medical Center Spine Conference November 11th, 2016

30 man R>L LBP, pain L hip numbness anterior thigh, SH: IT analyst PE: 5’8” 175 lb

TERMS• Spondylos : vertebra• Listhesis: slip• Spondylosis:

degenerative• Lysis: to separate• Optosis: falling• Discitis• Pars interarticularis:

area in between joints

Facts• Incidence 5% at age 6• Prevalence 6-10% in adults• Animal species• Ambulatory• Eskimos• Contributory behaviors• Anatomical studies• Where in spine?

Elongation of the pars area

Isthmus of Kho Phi Phi

SLIDING

Wiltse Spondylolisthesis types

• 1. dysplastic• 2. isthmic• 3. degenerative• 4. traumatic• 5. pathologic• 6. iatrogenic

Leon Wiltse, M.D.• June 27, 1913 - December 19, 2005. Leon was born in Lisbon, North Dakota, in 1913, one of eight brothers and two sisters. He received his B.A. and B.S. degrees in 1937 and 1938 from the University of North Dakota earning Phi Beta Kappa recognition. After serving his internship, he received his M.D. cum Laude from Northwestern University in 1941.

• During his three-year residency in orthopedics at Charity Hospital in New Orleans, he met and married Dorothy Stenehjem. Entering military service, Army Captain Wiltse was stationed at Walter Reed General Hospital in Washington, D.C., where he became chief of orthopedics.

• In 1948 the Wiltses moved to Long Beach, California, where Dr. Wiltse set up his orthopedic practice.

• In a career spanning more than fifty years, he served as a clinical professor of orthopedics at University of Louisiana Medical School, Walter Reed Army Medical Center, University of Texas' Southwestern Medical School and the University of California, Irvine.

• He led groundbreaking research including the first use of methyl methacrylate-a surgical plastic used to bond prostheses into joints. Dr. Wiltse also studied, described and classified spondylolistheses, a painful misalignment of the vertebrae of the lower back.

• With Robert Howland in 1985, he invented and developed the Wiltse Spine Fixation System. Just as important as his discoveriesand full-time practice, was the Wiltse Fellowship in Medicine and Surgery of the Spine. From 1971 until 1993, Dr. Wiltse mentored more than forty young spine surgeons.

• A prolific writer, Dr. Wiltse authored over 150 publications on the various aspects of orthopedics and traveled extensively to lecture internationally.

• In 2003 the Leon Wiltse Memorial Hospital was dedicated in Seoul, Korea. Dr. Wiltse was a member the American Academy of Orthopedic Surgeons, Western Orthopaedic Association, American Orthopedic Association, Soci Internationale de Chirurgie Orthopdique et de Traumatologie (President, American Section), President of the Association of Bone and Joint Surgeons, and founder and first president of both the International Society for the Study of the Lumbar Spine and the North American Spine Society, as well numerous local and regional medical associations. n Wiltse

Marchetti Bartolozzi

classification• Developmental

versus Aquired• Spondylolysis

with and without• Elongation of the

pars with and without

• Pars elongation from repetitive stress fracture

• Sacral endplate rounding

Blount’s disease• spondyloptosis

Sacral hook deficiency

Imaging

• Xrays• CT• MRI• Bone scan

An osteophytic bone and joint with subluxation is painful

video

thanks

Pelvic incidence

• Mean adult 57 deg

• >68.5 correlates to slip