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Spondylolisthesis: Grade II Slips (25-50%)

- Discussion:
    - those w/ symptomatic Grade II spondylolithesis should be restricted from activities such as gymnastics;
    - in younger children (ages 6 to 12), a slip of this degree is significant and highly likely to progress during the remaining growth years;
          - fusion should thus be done, even if the patient has no symptoms;
    - slip in a mature adolescent have a smaller risk of progression is far less;
          - symptomatic slips of 25-50 % should be fused, but asympotmatic can be periodically checked;
    - risk of progression:
          - young age at presentation, female sex;
          - slip angle > 10 deg (angle formed by intersection of lines parallel to inferior border of body of L5 & top of sacrum on lateral x-ray);
          - high grade slip;
          - domed shaped or significantly inclined sacrum (> 30 deg beyond vertical);

- Exam:

- Radiographic Findings:

- Non Operative Treatment:
    - majority of pts w/ symp. spondylolisthesis respond to conservative rx;
    - orthosis can be used as adjunct to conservative care based upon duration and severity of symptoms.

- Operative Treatment:
    - if non-op measures fail & operative treatment is indicated, bilateral arthrodesis of lateral column or transverse process is preferred;
    - posterior spine fusion is limited to those pts who do not respond to conservative measures & for those whose slip is greater than 50%;
          - fusion is performed to prevent total spondyloptosis;
          - L5 to S1 fusion is usually adequate;
    - in pts who have Grade-I or II spondylolisthesis, body of fifth lumbar vertebra is not usually tilted, and arthrodesis of the transverse 
          processes of 5th lumbar vertebra to ala of the sacrum is sufficient;
    - indications for reduction of slip are not clear at this time;
    - anterior & posterior fusions are carried out when slip is severe and associated w/ marked lumbosacral kyphosis

Brace treatment for symptomatic spondylolisthesis.