🦴 Section 720.6 · Spondylolysis & Spondylolisthesis

Nelson Textbook of Pediatrics 22nd Edition | Spondylolysis: defect in pars interarticularis (L5 most common, 4-8% of population). Spondylolisthesis: forward slippage of one vertebra on another (Meyerding classification I-V). Pain worse with extension (single-leg hyperextension test), hamstring tightness. Imaging: oblique radiograph (Scotty dog with collar), MRI (STIR) or SPECT for early detection. Treatment: low-grade (I-II) → conservative (activity modification, PT, bracing). High-grade (III-V) or progressive with neurologic deficit → surgery (posterolateral fusion ± reduction).

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📋 30 Clinical Scenarios — Spondylolysis & Spondylolisthesis

📇 High‑Yield Review Cards

🩺 Clinical Recognition: Spondylolysis/Spondylolisthesis

Select a presentation to review diagnostic clues and management per Nelson 720.6.

📋 Stepwise Management of Spondylolysis & Spondylolisthesis

🔑 Key Principles — Nelson Section 720.6
• Spondylolysis: Pars interarticularis defect (stress fracture). Most common L5 (85-95%). Associated with repetitive hyperextension (gymnasts, football linemen, wrestlers).
• Spondylolisthesis: Forward slippage of vertebra. Most commonly L5 on S1. Meyerding classification: I (<25%), II (25-50%), III (50-75%), IV (75-100%), V (spondyloptosis, >100%).
• Clinical presentation: Mechanical low back pain worse with extension, may radiate to buttocks. Hamstring tightness (popliteal angle). Palpable step-off in high-grade slips. Neurologic deficits rare but possible.
• Imaging: Standing lateral radiograph (slip percentage, slip angle). Oblique radiographs (Scotty dog with collar). MRI (STIR) for early stress reaction. CT for bony detail.
• Treatment: Low-grade (I-II) → conservative (activity modification, PT, TLSO brace). High-grade (III-V) or progressive/painful → surgery (posterolateral fusion ± reduction).

    ⚡ Reflex Prompts — Clinical Decisions

    📖 Summary: Spondylolysis & Spondylolisthesis (Nelson 720.6)