İstmik spondilolistezis

Özet

İstmik spondilolistezis, pars interartikülaris defektinin bulunduğu seviyede vertebra korpusunun çoğunlukla öne kaymasıyla tanımlanır ve tipik örnek L5'in S1 üzerinde kaymasıdır. Kontrastsız BT pars korteksini yüksek çözünürlükte gösterirken sagittal MPR kaymanın yönünü ve derecesini ortaya koyar. Pars defekti ile listezisin aynı segmentte birlikte gösterilmesi, yalnız kaymayı tanımlamaktan daha özgüldür. BT pars defektini gösterir; foraminal daralmanın derecesi nörolojik bulgular varsa MRG ile değerlendirilebilir.

Faz ve pencere

Kontrastsız tanısal

Çok kesitli BT ile çok düzlemlili rekonstrüksiyonlar, pars interartikülaris defektini ve genişleyişini en iyi şekilde görüntüler.

Önerilen pencereler: Kemik (G 1800 / M 400), Yumuşak doku (G 400 / M 40).

BT bulguları

• L5 pars interartikülarisinde tek veya iki taraflı defekt görülebilir.
• L5 korpusunun S1 üst endplate'ine göre öne translasyonu ve posterior vertebra çizgisinde basamaklanma
• Pars defekti ile anterolistezisin aynı L5-S1 segmentinde eşleşmesi
• Meyerding dereceleri: Grade I, <%25; Grade II, %25–50; Grade III, %50–75; Grade IV, %75–100; Grade V, >%100 kaymadır (spondiloptozis). Grade 0, Meyerding sınıflamasında düşük dereceli (Grade 0–II) grup içinde yer alır. Grade I–II düşük, Grade III–V yüksek dereceli kayma kabul edilir.
• L5-S1 disk aralığı daralması, son plak sklerozu veya intradiskal vakum gibi eşlik eden dejenerasyon
• BT pars defektini gösterir; nörolojik bulgular varsa MR foraminal veya santral stenozun derecesini değerlendirmede kullanılabilir.
• BT pars defektini gösterirken MR, kırık hattı çevresindeki kemik iliği ödemini saptayabilir. Pars çevresindeki kemik iliği ödemi MR ile saptanabilir.
• Meyerding sınıflaması üst vertebranın alt vertebraya göre kayma yüzdesini kullanır; %100'ü aşan kayma spondiloptozis olarak adlandırılır.

Ölçütler ve sınıflamalar

Meyerding kayma derecelendirmesi

Meyerding derecesi, kayan üst vertebranın alt vertebraya göre kayma yüzdesiyle belirlenir; ayakta lateral grafiler kaymanın varlığını veya derecesini değerlendirmede kullanılabilir. Grade I <%25, II %25–<50, III %50–<75, IV %75–100, V >%100 (spondiloptozis). Grade I–II düşük, Grade III–V yüksek dereceli kayma olarak sınıflandırılır. Ayakta lateral grafiler, istmik spondilolistezisin derecesini değerlendirmek için kullanılabilir.

Normalde

Normal L5-S1'de L5 posterior korpus kenarı S1 posterior korpus kenarıyla uyumludur ve L5 parsları pedikül ile laminayı kesintisiz kemik köprü olarak birleştirir. BT çok düzlemlili rekonstrüksiyonlar pars defektlerini ve kemik kanal sınırlarını netleştirirken, MR sinir kökü basısını değerlendirmek için uygundur.

Ayırıcı tanı

Dejeneratif spondilolistezis

faset artrozu ve disk dejenerasyonu öndedir, pars korteksi intakttır

Travmatik listezis

akut posterior eleman kırığı ve çevresel yumuşak doku değişikliği kaymaya eşlik edebilir; kronik kortike pars açıklığı beklenmez

Displastik spondilolistezis

L5 inferior fasetleri veya sakral üst fasetlerin gelişimsel şekil bozukluğu kaymanın temel anatomik zeminidir

İzole spondilolizis

pars defekti bulunmasına rağmen L5 korpusunun S1'e göre belirgin translasyonu yoktur

Spondiloptozis

istmik spondilolisteziste ileri kayma gelişebilir; pars defekti ve kayma BT'de çok düzlemli rekonstrüksiyonlarla birlikte değerlendirilebilir.

Tuzaklar

• Pars kırık hattı, lomber faset eklem hatlarından daha yatay seyretme eğilimindedir ve bu anatomik fark operasyon sırasında tanınmalıdır.
• Standart BT protokolü, kemik detaylarını en iyi gösteren yöntemdir ve pars defektinin genişliğini ve yönelimini değerlendirmede altın standart kabul edilir.
• Supin BT'deki kayma ayakta yük altında farklı olabilir; statik BT'den hareketli segment veya stabilite sonucu çıkarma.
• İleri foraminal daralma kemik penceresinde belirgin olsa da sinir kökünün gerçek basısı bu incelemede doğrudan gösterilmez; yumuşak dokular için MRG daha uygundur.

Kendini dene

1. L5 parsında defekt ve aynı seviyede spondilolistezis saptanıyor. En olası tanı hangisidir?

   • İstmik spondilolistezis
   • Dejeneratif spondilolistezis
   • İzole spondilolizis
   • Travmatik listezis
   Cevabı göster

   İstmik spondilolistezis. Aynı seviyedeki pars defektiyle birlikte görülen spondilolistezis istmik spondilolistezisi destekler.

2. L4 vertebrası L5 üzerinde öne kaymış; L4-L5 disk ve fasetlerde dejenerasyon, her iki L4 parsında intakt korteks var. Hangi mekanizma daha olasıdır?

   • Dejeneratif spondilolistezis
   • İstmik spondilolistezis
   • İzole spondilolizis
   • Akut pars kırığı
   Cevabı göster

   Dejeneratif spondilolistezis. L4-L5 segmentindeki dejenerasyon ve intakt L4 parsları, pars defekti olmaksızın gelişen dejeneratif spondilolistezis mekanizmasını destekler. İstmik tipte kayan vertebranın parsında defekt bulunur; izole spondiloliziste pars defekti vardır ama kayma yoktur; akut pars kırığında yeni kortikal ayrışma aranır.

İlgili konular

• Spondilolizis (pars defekti)
• Dejeneratif spondilolistezis

Kaynaklar

Bu sayfadaki 44 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 18 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.