Spondylolysis and Spondylolisthesis of the Lumbar …
Spondylolysis / spinal stenosis / spondylolisthesis
Spondylolysis and spondylolisthesis in the child ..
The underarm brace that your doctor prescribes may depend on your child's age and the center you visit. There are several types of braces, they typically have the same success rates, but your doctor will select one based on his/her experience with the different devices. The Wilmington brace is a custom-molded thoracolumbosacral orthosis that has molds to push and correct the curve (Figure 2). The Boston brace is similar, but uses pads inside the brace to push the curve (Figure 3). The Milwaukee brace, one of the first braces developed for scoliosis treatment, is less popular today due to its design. Your doctor will probably recommend that your child wear the brace fulltime. Some lumbar and thoracolumbar curves will be treated by a part time or night time brace. The Charleston and Providence braces are prescribed for eight to twelve hours a day, typically only during the hours of sleep. Braces are generally removed for bathing and special occasions. As your child grows, new braces will need to be fabricated, approximately every twelve to eighteen months.
Your pediatric spine surgeon will probably want to see your child every four to six months and have new front- and side-view X-rays made. They will then measure the curves and compare them with the previously made films. The doctor will probably continue to observe your child's curves as long as there is no drastic increase in the size of the curve. In some rare cases, the curve improves or even resolves (as in infantile scoliosis). If your pediatric spine surgeon documents progression of the curve, though, a different form of treatment will need to be instituted. He/she will probably want to obtain bending radiographs of the spine to assess flexibility and help determine the next course of treatment.
Spondylolysis and Spondylolisthesis
Most operations that address spinal deformity in the young child work by stopping growth. This may have unfavorable effects on growth of the thorax, lung development, and size of the trunk. The theory of the growing rod operation is to allow for continued controlled growth of the spine. This is done through the back of the spine. In general, the curve is spanned by one or two rods under the skin to avoid damaging the growth tissues of the spine. The rods are then attached to the spine above and below the curve with hooks or screws. The curve can usually be corrected by fifty percent at the time of the first operation (Figure 1). The child then returns every six months to have the rods "lengthened" approximately one centimeter to keep up with the child's growth. This is usually an outpatient procedure performed through a small incision. Most children will have to wear a brace to protect the instrumentation. When the child becomes older and the spine has grown, the doctor will remove the instrumentation and perform a formal spinal fusion operation. In the past, this procedure had a very high complication rate, most of which were related to the instrumentation (hook dislodgement, rod breakage). Newer techniques are more promising, such as rods that are expanded with a magnet placed on the patient's back in the outpatient clinic and do not require scheduled expansions in the operating room. However, treatment with growing rods remains a long and difficult therapy for the child.
Spondylolysis starts with a stress fracture in a small area of bone at the back of the vertebra called the pars interarticularis. If the stress fracture/spondylolysis is allowed to worsen, it may result in a related condition known as spondylolisthesis.
Spondylolysis & Spondylolisthesis | Lurie Children's
Posterior fusion provides permanent stabilization in the corrected position and is achieved by removing the joints between the vertebrae to be fused, usually all the vertebrae which are involved in the curve. Bone graft - either from the pelvis, ribs, or from the bone bank (allograft) - is placed in each joint space which has been removed. Over time (4-6 months), the graft incorporates to the vertebral bone, and the operated portion of the spine heals into a solid block of bone which cannot bend, thus eliminating further progression of the curve. Typically in a child who has reached an appropriate age for definitive fusion, instrumentation will also be placed when the fusion is performed. The instrumentation rigidly fixes the spine internally, so that the corrected position is carefully preserved while the fusion takes place over the 4-6 month period. This rigid fixation is achieved by screws, hooks, and wires ("anchors") attached to the spine, usually at multiple sites along the curve, and then rods are attached to the anchors to stiffen the entire area. Depending on the flexibility of the curve and any preceding treatment (such as traction), there may be additional correction of the deformity achieved by the application of the instrumentation. However, the primary goal of the surgery is to stop the curve from progressing further, and thus be the definitive stabilization - additional correction is an added benefit but not the primary concern. Often the patient does not need any further external immobilization (cast or brace) if the internal fixation device is felt to be adequate at the time of surgery.
Treatment options for Pediatric/Adolescent Spondylolisthesis;
The Management of Spondylolysis and Spondylolisthesis
Prospective international study2 • Boston brace in girls with 25-35 degree curves – 74% ..
Spondylolysis and Spondylolisthesis of the Lumbar Spine
Treatment Options for Pediatric/Adolescent Spondylolysis and Spondylolisthesis ..
Spondylolysis & Spondylolisthesis; Glossary; ..
Treatment Options for Pediatric/Adolescent Spondylolysis and Spondylolisthesis;
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