Review Question - QID 6102

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Pediatric Spondylolysis & Spondylolisthesis QID: 6102 (SAE07PE.42)

QID 6102 (Type "6102" in App Search)

A 14-year-old boy reports a 4-month history of increasing backache with difficulty walking long distances. His parents state that he walks with his knees slightly flexed and is unable to bend forward and get his hands to his knees. He denies numbness, tingling, and weakness in his legs and denies loss of bladder and bowel control. A lateral radiograph of the lumbosacral spine is shown in Figure 18. What is the best surgical management for this condition?

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Vertebrectomy of L5

25/1151

Posterior spinal fusion with or without instrumentation from L4 to S1

79%

913/1151

Posterior spinal fusion without instrumentation from L5 to S1

104/1151

Anterior spinal fusion from L4 to L5

33/1151

Direct repair of the spondylolysis defect

65/1151

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The patient has a grade 4 spondylolisthesis. Optimal surgical management is posterior spinal fusion from L4 to the sacrum. The use of instrumentation is controversial. Vertebrectomy is typically reserved for spondylo-optosis (grade 5) cases. Spinal fusion from L5 to S1 usually is not successful for a slip that is greater than 50%. Isolated anterior spinal fusion has not been successful, and direct repair of the pars defect is only useful for spondylolysis without spondylolisthesis.