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George R. Prioleau and Charles B. Wilson

S pondylolysis with spondylolisthesis of the lumbar spine is found in approximately 5% of the general population. 7 It is observed most frequently at L-5, occasionally at L-4, but rarely above this level. Spondylolisthesis of the cervical spine was first reported by Perlman and Hawes in 1951. 6 Six additional cases have since been reported; however, none of these patients had neurological deficits and all had defects at only one level. 1–4 We are reporting a case of multilevel defects of the pars interarticularis with spondylolisthesis and associated

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Yoichi Shimada, Yuji Kasukawa, Naohisa Miyakoshi, Michio Hongo, Shigeru Ando and Eiji Itoi

T he upper and middle regions of the thoracic spine are well stabilized by the rib cage and facet joints, especially in the anteroposterior direction. Although in cases of trauma the thoracolumbar junction is particularly vulnerable because this is the transitional region where the stable thoracic spine becomes the mobile lumbar region, there have been only a few reported cases of myelopathy due to thoracic spondylosis. 8 , 9 Thoracic spondylolisthesis is considered to be a cause of thoracic myelopathy; 7 however, there have been very few reports of

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Neurosurgical Forum: Letters to the Editor To the Editor Y. Nubourgh , M.D. CHU du Charleroi Charleroi, Belgium 357 358 Abstract Object. The purpose of this study was to assess radiologically demonstrated results and clinical outcomes in patients with degenerative spondylolisthesis who underwent posterior decompressive surgery via a new (unilateral) approach. This approach allows surgeons to perform central and bilateral decompression while only stripping the muscles unilaterally, thus preserving the posterior

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Xinyu Liu, Lianlei Wang, Suomao Yuan, Yonghao Tian, Yanping Zheng and Jianmin Li

Among the general population, the estimated incidence of lumbar spondylolysis is 3%–10% and that of isthmic spondylolisthesis is 2.6%–4.4%. 4 Lumbar spondylolysis and isthmic spondylolisthesis occur most commonly at a single spinal level, usually the unilateral or bilateral L-5 pars interarticularis. Only a few cases of multiple-level lumbar spondylolysis have been reported. 1–3 , 5–11 Ravichandran 8 calculated that only 1.48% of patients with back pain have multiple-level spondylolysis. Sakai et al. 9 reviewed CT scans of 2000 persons without low

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Cheerag D. Upadhyaya, Sigurd Berven and Praveen V. Mummaneni

P edicle subtraction osteotomy is a powerful technique for the correction of a fixed sagittal plane deformity. This type of osteotomy has been associated with significant perioperative morbidity, 1 , 2 , 4–6 which we have described as > 50% in patients undergoing PSO in a revision setting. We here report a rare case of pseudarthrosis at the level of a PSO due to spondylolisthesis of the PSO segment. Case Report History and Examination This 50-year-old man who had undergone 4 prior thoracolumbar operations over the past decade presented with

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Julian Chell and Richard C. Quinnell

T he rationale for the treatment of spondylolisthesis has been based both on its pathoanatomy 17 and on the degree of displacement, expressed in terms of the percentage of slippage of one vertebral body onto another. 12 The treatment of high-grade slippage, Grades III or higher (that is, > 50%), remains controversial. Various methods of in situ stabilization of high-grade slippage have been proposed, including posterolateral fusion with 9 or without decompression, 13 posterior interbody fusion, 7, 10 posterior fusion with instrumentation, 16 anterior

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Aruna Ganju

Isthmic spondylolisthesis, which is demonstrated in 4 to 8% of the general population, is one of the most common types of spondylolisthesis. The three subtypes of this condition all manifest some variation of a pars interarticularis defect as a result of recurrent injury to that structure. A multifactorial origin is postulated for this disease; mechanical, hereditary, and hormonal factors are believed to play a role. Presenting signs and symptoms may include those referable to neurological compromise or those related to the spinal deformity. The majority of patients with spondylolysis and spondylolisthesis respond to conservative, nonoperative treatment. Pain, neurological compromise, and cosmetic defects unresponsive to traditional therapies may require surgical intervention. Surgical options include any combination of the following: neural decompression, bone fusion, instrument-assisted fusion, and reduction. In this paper, the natural history and treatment options are presented, and the supporting literature is reviewed.

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Arthur Kobrine and Paul C. Bucy

S pondylolysis is thought by most to be a congenital defect in the pars interarticularis of the vertebra and the precursor of spondylolisthesis. 19 We are reporting the case of a boy who had an unusual herniated lumbar intervertebral disc, and developed both spondylolysis and spondylolisthesis in the postoperative period. Case Report This 13-year-old boy was first seen by us on April 14, 1960, because of insidious development of pain in the left knee since September, 1959. There was no history of trauma nor any other obvious cause for the pain

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Michael Kern, Matthias Setzer, Lutz Weise, Ali Mroe, Holger Frey, Katharina Frey, Volker Seifert and Stephan Duetzmann

T he treatment of spinal stenosis and degenerative spondylolisthesis is controversial. Two large randomized clinical trials reported contradictory results. 10 , 11 Recent registry clinical outcome data could not prove superiority of upfront fusion. 4 It is obvious that the complex spinal anatomy and clinical history of each patient mandates individual decision making. The fusion procedure can address not only the stenosis but also the sagittal balance, and improved balance can lead to better outcome. 23 On the other hand the convergence of several demographic

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Sait Naderi, Metin Manisali, Feridun Acar, Dinç Özaksoy, Tansu Mertol and M. Nuri Arda

L umbosacral spondylolisthesis is a common spinal disorder that often requires a stabilization and fusion procedure. A variety of surgical treatment strategies have been devised for LSS, including transpedicular fixation with or without reduction, bone- or interbody cage—assisted anterior or posterior lumbar interbody fusion, facet screw fixation, and some combined procedures. 2, 4, 6, 11, 14, 18, 23–26, 28–30 Regardless the fixation procedure, the main goal is to decompress the neural elements and stabilize the unstable spinal segment(s). Whereas the