Spinal Fractures, Spondylolysis and Spondylolysthesis

Spinal fractures and posterior element abnormalities including spondylolysis and spondylolisthesis remain quite common in individuals with osteogenesis imperfect (OI). Treatment with bisphosphonates has allowed individuals previously wheelchair-bound to become more active and assume a bipedal posture in many cases. This increased activity places individuals at more risk of acute fracture and more chronic repetitive stress to the spine. Spinal fractures have been noted to improved morphology with treatment of bisphosphonates, at least in infants and young children. This has also been observed in older individuals but not as predictably.Bracing and surgery in the treatment of fractures of the vertebral body in OI requires further study. At this point treatment must be individualized. Spondylolysis and spondylolisthesis occur at a higher frequency in children with OI who have been treated with bisphosphonates and who are ambulatory. Optimal treatment and risk of progression of spondylolisthesis are not yet defined.