[The history of spondylolisthesis. The nineteenth century: early case reports, terminology, etiology and pathogenesis]. / Zur Geschichte der Spondylolisthese. Das 19. Jahrhundert: Frühe Fallberichte, Terminologie, Ätiologie und Pathogenese.

The author describes the history of research and development of knowledge on lumbar spondylolisthesis. Based on the available literature, early case reports, creation of the terminology and etiological concepts are presented.

Walter Mercer's (1891-1971) contribution to the surgical treatment of low back pain.

In 1936, Walter Mercer described a new method for the operative treatment of patients with spondylolisthesis. Using a transabdominal approach in two patients he inserted iliac crest bone graft into the intervertebral disc. His publication in the Edinburgh Medical Journal caused a furore as the levels operated on did not reflect the description and one of the two patients died post-operatively. However, Mercer continued to promote the operation in his textbooks. The anterior approach to the lumbar spine is now performed routinely. This paper explores Mercer's contribution to anterior spinal surgery.

Spondylolysis, spondylolisthesis, and lumbo-sacral morphology in a medieval English skeletal population.

The prevalence of spondylolysis and spondylolisthesis was studied in an adult skeletal series from a rural English medieval archaeological site. Attempts were made to evaluate the association of three aspects of lumbo-sacral skeletal morphology (pelvic incidence (a measure of the anterior inclination of the sacral table), lumbar transverse process width, and the presence of lumbo-sacral spina bifida occulta) with spondylolysis and spondylolisthesis. Results indicated a high prevalence of spondylolysis compared with a modern reference population, but few cases of spondylolisthesis were identified. Analysis of prevalence with respect to age suggests that in the study population, pars interarticularis defects generally formed late in the growth period or early in adult life. The study group showed a high mean pelvic incidence compared with modern Western Europeans, indicating a more steeply inclined sacral table, which may have elevated the risk of developing pars interarticularis defects. However, no statistically valid association could be demonstrated between the presence/absence of spondylolysis and pelvic incidence in the study material. There was no evidence for a link between lumbar transverse process index or lumbo-sacral spina bifida occulta and spondylolysis/spondylolisthesis. It is concluded that the potential role of lumbo-sacral morphology, as well as of activity regimes, should be considered when interpreting spondylolysis in paleopathological studies. If the frequency of spondylolysis is to some extent an indicator of past activity regimes, it may reflect lifestyle in younger individuals rather than in mature adults. Further work investigating the link between spondylolysis and lumbo-sacral morphological variables in premodern populations would be of value.

Deformity in the "Boxing Boys".

The late Bronze Age wall painting the Boxing Boys (c. 17th-16th century BCE) was excavated in the ancient town of Akrotiri on the Greek island of Thera. This article considers a medical interpretation for the spinal-pelvic anomaly in the anatomy of one of the boys. The artist has depicted a combination of structural anatomical adjustments diagnostic of spondylolisthesis, a forward slippage of one of the lumbar vertebrae. The accurate portrayal of the surface appearance of this condition suggests that the artist painted directly from a live subject. Thus, the Boxing Boys mural may be the earliest visual record of a sports-induced injury. Although the meaning of the wall paintings is unclear, the wild goats (agrimia) on the adjoining walls simulate swayback as a reflection of the boy's torso deformity and share other features with the boxers, adding to the unifying characteristics of the room. The abnormal morphology appears to be the earliest achievement of transforming disease into aesthetic charm on a monumental scale.

Who was Meyerding?

Henry William Meyerding is best known for his spondylolisthesis classification system, but he achieved much more while working at the Mayo Clinic, Minnesota, during the first half of the 20th century. A brief biography is presented, as well as some personal insights into the character of H. W. Meyerding.

Asymmetrical spondylolysis.

The objective of this study was to examine examples of spondylolysis in which the pattern of separation was clearly asymmetrical, in order to learn more about the process of bone separation that produces this condition. Although the primary focus was on unilateral complete separation, examples of asymmetry represented by incomplete separation and by complete bilateral separation where the separation sites are in different locations on the two sides were included. Two collections were used, one consisting of Canadian Inuit skeletons curated at the Canadian Museum of Civilization, and the other of 48 individual examples of asymmetrical spondylolysis from sites in a variety of localities curated by several different institutions. The first collection was studied primarily to observe early manifestations of spondylolysis, particularly incomplete separation, while various patterns of asymmetrical complete separation were the focus of the second. The results indicate that asymmetry is part of the earliest osteological picture of spondylolysis, with right-sidedness predominating, a condition perhaps related in some way to handedness. The right-side predominance appears to decrease with age. The ratio of unilateral to bilateral separation ranges from 3-33% in different studies, and a significant number of the unilateral separations have spina bifida occurring in the same vertebra. Overall, the specimens examined here, considered along with clinical cases, nicely illustrate a progression of spondylolysis. A unilateral separation may heal, it may progress to bilateral separation, or it may remain as a permanent condition, producing a pattern of degenerative changes that can include spondylolisthesis. A unilateral healing of bilateral complete separation is likely a rare phenomenon, at least after the separations have reached a certain level of maturity.

Preoperative reduction of spondylolisthesis.

The treatment of SL, especially in some cases, is mostly surgical. This lesion can be considered an extremely localised kyphosis (only two vertebrae) or a localized (sub-)luxation: at most hearetically pre-operative reduction should represent the first stage of the treatment, also because reduction makes further surgery easier and enables us to obtain the best results. After a glance at the various surgical techniques that have been used in the past, we describe our method of preoperative reduction in case of severe SL, an improvement of Scaglietti's original technique. According to the parameters taken into consideration, spondylolisthesis (SL) of the 4th and, above all, the 5th lumber vertebrae can be considered, especially in severe cases, as kyphosis or displacement (or even dislocation in the case of ptosis). In SL-kyphosis the antero posterior axes of the contiguous vertebral bodies are no longer parallel but tend to over-impose one to the other anteriorly forming an open posterior angle of varying degrees. It is an extremely short kyphosis (only two vertebrae) but from all points of view, even therapeutic, it reflects the characteristics of all types of vertebral kyphosis. SL-subluxation or SL-luxation (ptosis) is characterized by the respectively partial or total loss of normal alignment between the vertebrae involved. This can be explained by the fact that nearly all those who have dealt with the problem of treating SL, especially of L5, always ask themselves beforehand if it is possible and/or opportune to eliminate or improve the condition before surgery. In other words the question of reduction (pre or intraoperative, partial or total) of more or less severe L5 SL is always considered by all authors, even if their conclusions are often in disagreement.

Spondylolysis and its relationship to degenerative joint disease in the prehistoric southeastern United States.

Spondylolysis, a fatigue fracture in the neural arch of lumbar vertebrae, is common in Eskimos and some athletes. In Archaic Indians from northwestern Alabama, 17% of males and 20% of females with complete lumbar regions showed this defect. It is found at a fairly early age in adult males in this group, but in females it does not appear until after age 40 years. Spondylolysis is associated with higher levels of osteoarthritis around the fifth lumbar vertebra, where this defect typically occurs. Otherwise, there is little relationship between its presence and degenerative joint disease, especially in the weight-bearing joints. The incidence in young males may be related to activities necessitating a high level of mobility around the lumbar spine. The late occurrence in females suggests that osteoporosis may have been a contributing factor.

Traumatic spondylolisthesis of the axis.

Hanging, a common method of execution, began in antiquity and continues to this date. Unfortunately, the exact cause of a victim's demise was not always obvious, and many victims died as the result of asphyxiation from the hangman's noose. In the latter part of the 19th century, scientific curiosity led to autopsy studies of the cervical spine; Paterson in 1890 first described the lethal lesion. Experimental work in 1913 demonstrated that when the hangman's knot was placed beneath the chin, death rapidly occurred because of a traumatic spondylolisthesis of the second cervical vertebra. This knot placement then became standard as the most efficient method of execution. It was not until the mid-20th century that the similarity between judicial and civilian injury was recognized. The reports were infrequent, and most of the pars interarticularis fractures resulted from automobile accidents in which the victim was thrown forward and struck his or her face against the windshield which caused sudden violent hyperextension. The similarity between civilian and vehicular injuries was recognized in 1965 by Schneider who, together with his associates, reported eight cases; it was this group who introduced the term "hangman's fracture". Garber presented his thoughts on this subject, noting that there was a difference between the forces generated by judicial hanging and those caused by motor vehicle accidents and other similar civilian injuries. The former results in axial loading and hyperextension, and, rarely, in flexion or axial loading. Since the lesion occurs at the pars interarticularis of C2, Garber suggested that a more appropriate term might be traumatic spondylolisthesis of the axis.

[Unilateral spondylolyses in Slavic and Slavic-Avaric populations]. / Unilaterale Spondylolysen bei slawischen und slawisch-awarischen Populationen.

The authors consider the spondylolysis a polyetiologic abnormality with an important part of congenital factors in its origin. The frequency of spondylolysis can be considered a feature characterizing a population. This opinion is confirmed by finds in skeletal materials from old Slavonic and Slavonic-Avaric cemeteries. The frequency of spondylolysis in the Slavonic part is significantly lower than in the Slavonic-Avaric part of the materials. The share of unilateral spondylolysis is also different (15 and 7%) when comparing these two population groups, but statistically insignificant. The so-called "combined" type of spondylolysis is, however, significantly higher in the number of unilateral cases of spondylolysis than in the bilateral ones.