Many patients with spondylolysis are asymptomatic. Of those with symptoms, approximately one-quarter are associated with spondylolisthesis.3 Pain is usually limited to the low back. If the pain radiates, it is usually to the buttocks or the back of the thigh and is often from hamstring tightness rather than lumbar radiculopathy. With associated higher grade spondylolisthesis, however, radiculopathy becomes more common due to associated foraminal stenosis.
In the evaluation of degenerative spine disease, multiple anatomic sites need to be imaged,including the intervertebral disk, spinal canal, spinal cord, nerve roots, neuroforamina, facet joints,and the soft tissues within and surrounding the spine. Many pulse sequences are available, andspecific protocols vary among different MR sites. There is general agreement that the spine needsto be imaged in at least two planes, and surface coils are used almost exclusively. In the cervical andthoracic regions a T2-weighted sequence is mandatory to assess damage to the spinal cord. Thinsections are required to visualize the neuroforamina, and pulse sequences must be tailored tocounteract CSF flow and physiologic motion. The imaging requirements for the lumbar spine are lessstrenuous because the anatomical parts are larger. Most protocols include a T1-weighted sequenceand some type of T2-weighted sequence to give a myelographic effect. Fast spin-echo (FSE)techniques allow enormous time savings, and if available, they have replaced conventional spin-echofor T2-weighted imaging of the spine. Three-dimensional gradient-echo (GRE) methods can achieveslice thicknesses less than one millimeter, an advantage for displaying cervical neuroforamina.
Lumbar Spondylolisthesis - Spondylolisthesis
Clinical History: A 22 year-old man presents with right-sided back pain which radiates to his right hip and leg. His symptoms began while running. (1a) T1- and (1b) T2-weighted sagittal and (1c) T2-weighted axial images of the lumbar spine are provided. What are the findings? What is your diagnosis?
Scoliosis And Spional Listhesis – 567227 – ARC
Ulmer and colleagues proposed the "wide canal sign" to distinguish between isthmic anddegenerative spondylolisthesis. Using a midline sagittal section, they noted that the sagittal canalratio (maximum anteroposterior diameter at any level divided by the diameter of the canal at L1) didnot exceed 1.25 in normal controls and in subjects with degenerative spondylolisthesis. In patientswith spondylolysis, the measurement always exceeded 1.25.
Spondylolisthesis | Spine Institute of San Diego
The sagittal plane is best fordisplaying the abnormal anatomy ofspondylo-listhesis, T2-weighted imagesfor the canal and T1-weighted images forthe pars interarticularis and neuralforamina. The sagittal view clearlyshows the degree of subluxation and therelationship of the intervertebral disk tothe adjacent vertebral bodies and thespinal canal. Parasagittal images aregood for showing encroachment on theforamina by disk or hypertrophic bone. Loss of the normal fat signal cushioningthe nerve root is a sign for significantforaminal stenosis.
Spondylolisthesis - Spondylolisthesis
(10a) A T1-weighted sagittal image reveals Grade I spondylolisthesis at L4-5 (arrow). No definite pars defects were evident on peripheral sagittal images (not shown), though visualization of the pars region was suboptimal.
Spondylolisthesis was first described in 1782 by ..
With the pars defect divides the vertebrainto an anterior part (vertebral body,pedicles, transverse processes, andsuperior articular facet) and aposterior part (inferior facet, laminae, and spinous process). The anterior part slips forward, leavingthe posterior part behind. As a result, the spinal canal elongates in its anteroposterior dimension, sothat spinal canal stenosis is uncommon with isthmic spondylolisthesis. Grade I spondylolisthesis isoften asymptomatic, but with progressive anterior subluxation, the intervertebral disk and theposterior-superior aspect of the vertebral body below encroach on the superior portion of the neuralforamen. The foramen is also elongated in a horizontal direction and may have a bilobedconfiguration. Exuberant fibrocartilage at the pars pseudarthrosis can further compromise the neuralforamen and cause nerve root compression.