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2 CATEGORIZING THE TYPES Spondylolisthesis is divided into five categories. 2 These categories designate the primary cause and pathological progress of the condition. Type 1 (Dysplastic) This variation occurs as a result of genetic abnormalities in the facet joints of the spine. Excessive loading of the spine may not be necessary to cause problems because this is a genetic structural defect in the architecture of the spine. Type 2 (Isthmic) Type 2 or isthmic spondylolisthesis results from advancing spondylolysis. Stress fractures in the pars lead to the eventual vertebral slippage. There may be some overlap between genetic factors in Type 1 and Type 2. For example, Type 2 occurs with increased frequency in northern Native American and Eskimo populations. 3 Type 3 (Degenerative) In some cases, degeneration of the intervertebral disks, usually accompanied by exaggerated lumbar lordosis, can cause forward slippage of the vertebrae. This variation is more common in women. One possible cause of the increased incidence with females is hormone-induced ligamentous laxity that does not provide adequate stabilization and support for the vertebrae. Type 4 (Traumatic) This type is not common but can occur as a result of sudden violent injury to the spine. In this instance, there is usually a very high force load that causes an acute fracture to the pars or neural arch of the vertebrae and there is subsequent forward slippage. Type 5 (Pathological) This variation results from bone diseases, tumors, or infections that lead to a breakdown in spinal structures and eventual vertebral slippage. ASSESSMENT AND EVALUATION Spondylolysis and spondylolisthesis can both have very similar symptoms. The most common complaints include localized low-back pain in the lumbosacral region. The pain can extend into the buttock or posterior thigh region. Pain usually increases during activities involving spinal extension, whether performed actively or passively. Pain is likely to decrease in activities involving spinal flexion, such as bending forward. This position takes the posterior load off the spinal structures. During palpation, there may be localized tenderness of muscles and other soft tissues in the region. Soft-tissue tenderness is not likely related to damage of the soft tissues themselves. This tenderness is more likely a result of increased sensitivity of neural structures in the area. In more severe cases, there may be neurological symptoms that mimic lumbar nerve root pathology. If the fracture site in the pars interarticularis is in a certain position, the edge of the bone may snag the nerve root Activities with greater lumbar extension stress posterior vertebral arch structures. Image courtesy Wikimedia Commons. Yo u r M & B i s w o r t h 2 C E s ! G o t o w w w. a b m p . c o m / c e t o l e a r n m o r e . 91 Repeated compressive loading of the posterior arch can cause small stress fractures to develop in the region of the pars. These small fractures are spondylolysis.

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