Spine: high-grade spondylolisthesis in an adolescent: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Spine: high-grade spondylolisthesis in an adolescent

Sample item

A 13-year-old girl has low back pain, a waddling gait with tight hamstrings and a flat buttock contour. A lateral radiograph shows L5 slipped forward by 60 percent of the width of S1. What is the most appropriate treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Posterior fusion of L5 to S1

A slip of 50 to 75 percent is Meyerding grade III. High-grade slips in a growing child tend to progress and cause neurological and postural problems, so fusion is advised. Low-grade slips are managed conservatively.

Option by option

  • A. Direct repair of the pars defect

    Pars repair is only for a young patient with a defect and little or no slip.

  • B. Posterior fusion of L5 to S1 (correct)

    Correct. A grade III slip with hamstring tightness in a child is treated by fusion of L5 to S1.

  • C. Thoracolumbosacral bracing for six months

    Bracing may be tried in low-grade slips and will not control a high-grade progressive slip.

  • D. Observation with restriction from sports

    Observation suits low-grade asymptomatic slips and not a 60 percent slip with symptoms.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Orthopaedics questions

Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is B, Posterior fusion of L5 to S1. A slip of 50 to 75 percent is Meyerding grade III.

Why is "Direct repair of the pars defect" not the answer?

Pars repair is only for a young patient with a defect and little or no slip.

Why is "Thoracolumbosacral bracing for six months" not the answer?

Bracing may be tried in low-grade slips and will not control a high-grade progressive slip.

Why is "Observation with restriction from sports" not the answer?

Observation suits low-grade asymptomatic slips and not a 60 percent slip with symptoms.

What concept does this question test?

It tests Spine: high-grade spondylolisthesis in an adolescent in Orthopaedics. High-grade slips in a growing child tend to progress and cause neurological and postural problems, so fusion is advised. Low-grade slips are managed conservatively.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Spine: high-grade spondylolisthesis in an adolescent?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.