Zackery

Children with athetosis may develop lumbar spondylolisthesis in childhood, occasionally requiring fusion for spondylolisthesis. Zackery, a 12-year-old boy, presented in orthopedic clinic with a complaint of back pain, especially after walking long distances. A gait analysis showed very high variability in step length and most kinematic parameters. He had no fixed contractures on physical examination. An x-ray of his spine demonstrated L5 spondylolysis with grade one spondylolisthesis. Image 5-9.1 An attempt at conservative treatment with a lumbar flexion jacket for six months demonstrated no significant decrease in the pain, therefore, it was recommended he have a posterior lateral arthrodesis from L4 to the sacrum. A posterior spine arthrodesis was performed and after this healed all of his back pain resolved. Most of these children develop the spondolysis in middle childhood and most become asymptomatic with a three to six month course of treatment with a lumbar flexion jacket. There is no published evidence to suggest that this spondylolysis becomes a problem in later life, unlike the widely recognized problems of degenerative arthritis of the cervical spine.

Go To Quiz