Management of spondyloptosis

Abstract

Spondyloptosis is a condition characterized by complete slip of one vertebral body over another, more commonly seen at the L5 on S1. High-grade slips and spondyloptosis have been associated with high pelvic incidence which increases the shear forces across the lumbosacral junction which further aggravates the slip angle. Additionally, posterior element defects have been noted in a high percentage of patients. Spondyloptosis is often associated with back pain and symptoms of spinal canal stenosis along with sagittal plan deformity with or without compensatory coronal plane deformity. While conservative management is usually the first line of treatment, surgical intervention is often required to control patient symptoms. The surgical management for high-grade slips including spondyloptosis is controversial and ranges from neural decompression, In situ fusion, partial or complete reduction of slip with or without vertebral resection. In this chapter, we will review the different approaches to this problem described in the literature. The surgeon should tailor the best management for the patient based on symptoms and magnitude of deformity.