title: Multiple-level lumbar spondylolysis and spondylolisthesis.
abstract: OBJECTIVE
  Lumbar spondylolysis and isthmic spondylolisthesis occur most commonly at only one spinal level. The authors report on 13 cases of lumbar spondylolysis with spondylolisthesis at multiple levels.
  
  
  METHODS
  During July 2007-March 2012, multiple-level spondylolysis associated with spondylolisthesis was diagnosed in 13 patients (10 male, 3 female) at Qilu Hospital of Shandong University. The mean patient age was 43.5 ± 14.6 years. The duration of low-back pain was 11.7 ± 5.1 months. Spondylolysis occurred at L-2 in 2 patients, L-3 in 4 patients, L-4 in all patients, and L-5 in 5 patients. Spondylolysis occurred at 3 spinal levels in 3 patients and at 2 levels in 10 patients. All patients had spondylolisthesis at 1 or 2 levels. Japanese Orthopaedic Association and visual analog scale scores were used to evaluate preoperative and postoperative neurological function and low-back pain. All patients underwent pedicle screw fixation and interbody fusion or direct pars interarticularis repair.
  
  
  RESULTS
  Both low-back pain scores improved significantly after surgery (p < 0.05). Postoperative radiographs or CT scans showed satisfactory interbody fusion or pars interarticularis healing. No breakage, dislodging, or loosening of the pedicle screw hardware was observed for any patient.
  
  
  CONCLUSIONS
  Multiple-level lumbar spondylolysis and spondylolisthesis occurred more often in men. Most multiplelevel lumbar spondylolysis occurred at 2 spinal levels and was associated with sports, trauma, or heavy labor. Multiplelevel lumbar spondylolysis occurred mostly at L3-5; associated spondylolisthesis usually occurred at L-4 and L-5, mostly at L-4. The treatment principle was the same as that for single-level spondylolisthesis.
authors.affiliation: Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Xinyu
authors.initials: X
authors.lastname: Liu
authors.forename: Lianlei
authors.initials: L
authors.lastname: Wang
authors.forename: Suomao
authors.initials: S
authors.lastname: Yuan
authors.forename: Yonghao
authors.initials: Y
authors.lastname: Tian
authors.forename: Yanping
authors.initials: Y
authors.lastname: Zheng
authors.forename: Jianmin
authors.initials: J
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D017116:Low Back Pain / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008161:Lumbosacral Region / Q000601:surgery; D008297:Male; D008875:Middle Aged; D013123:Spinal Fusion / Q000379:methods; D013168:Spondylolisthesis / Q000175:diagnosis / Q000601:surgery*; D013169:Spondylolysis / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
keywords: JOA = Japanese Orthopaedic Association; VAS = visual analog scale; lumbar spine; multiple-level; spondylolisthesis; spondylolysis