AIS and spondylolisthesis

Abstract

Introduction: The association of scoliosis and spondylolisthesis is well documented in literature; the nature and modalities of the relationship of the two pathologies are variable and not always clear. Also, etiologic particulars of scoliosis associated with spondylolisthesis are not well defined, even in cases where scoliosis is called idiopathic. In this paper, we review previous literature and discuss the different aspects of the mutual relationship of scoliosis and spondylolisthesis in the adolescent age.

Materials and methods: It is a common notion that the highest occurrence of scoliosis associated with spondylolisthesis is at the lumbar level, both in adolescent and in adult patients. It is probable that the scoliosis that is more heavily determined by the presence of spondylolisthesis is at the lumbar level and presents curve angle lower than 15° Cobb and mild rotation. The scoliosis with curve value over 15° Cobb that is present at the lumbar level in association with spondylolisthesis probably is not prominently due to spondylolisthesis: in these cases, spondylolisthesis is probably only partially responsible for scoliosis progression with a spasm mechanism and/or due to rotation of slipping "olisthetic" vertebra.

Discussion: We think that the two pathologies should be treated separately, as stated by many other authors, but we would highlight the concept that, whatever be the scoliosis curve origin, spasm, olisthetic or mixed together, this origin has no influence on treatment. The curves should be considered, for all practical effects, as so-called idiopathic scoliosis. We think that generally patient care should be addressed to treat only spondylolisthesis or only scoliosis, if it is necessary on the basis of clinical findings and therapeutic indications of the isolated pathologies, completely separating the two diseases treatments.

Conclusions: Scoliosis should be considered as an independent disease; only in the case of scoliosis curve progression over time, associated scoliosis must be treated, according to therapeutic principles of the care of any so-called idiopathic scoliosis of similar magnitude, and a similar approach must be applied in the case of spondylolisthesis progression or painful spondylolisthesis.

Fig. 1

Male, 15 years old. a Scoliosis in L5 spondylolisthesis, maximum olisthetic rotation at L5 level, b Scoliosis in L5 spondylolisthesis, maximum olisthetic rotation at L5 level, associated with high idiopathic scoliosis. 1-AP X-rays projection 2-LL X-rays projection 3-CT scan, showing asymmetric “gap”

Fig. 2

Female, 16 years old. Spondylolisthesis L5 II grade associated with opposite scoliosis curve at upper level, 47° Cobb, with opposite rotation. L5 is below iliac crests line, as it is easy to note in the particular. The arrows show the different rotation in the spine. a AP X-rays projection standing, b AP X-rays projection standing particular, c LL X-rays projection standing

Fig. 3

Female, 13 years old. a Scoliosis associated with spondylolisthesis I grade, b after correction with arthrodesis down to L4, c AP and LL X-rays standing at follow-up 8 years and 3 months after operation, stable scoliosis correction without spondylolisthesis worsening

Fig. 4

Female, 13 years and 6 months old. a Spondylolisthesis L4 IV grade without scoliosis AP and LL X-rays standing, b particular of spondylolisthesis, c MRI view, d first stage: anterior approach, bone grafting, rebalance tilting L5, e second stage: posterior approach and instrumentation stabilization, f follow-up 2 years after operation, correction stability, g follow-up 4 years after operation, control 2 years after instrumentation removal, complete fusion with stability

Fig. 5

Female 10-year-old spondylolisthesis IV grade, symptomatic lumbar sciatic pain a Spine LL X-rays projection standing, b lumbar spine MRI, c spine AP X-rays projection standing no scoliosis, d picture of the patient with antalgic posture, lumbar–sacral tract kyphosis, lordosis in the upper spine tract; hips and knees bent

Fig. 6

Female 15 years 8 months old. a Spine AP X-rays projection standing scoliosis in high thoracic area and straight lumbar spine, b spine LL X-rays projection particular showing spondylolisthesis I grade