Selected monographs.

  • New Sydenham Society.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    processes cau be pointed out, where in fact these processes are unaltered, nothing can he supposed except this questionable primary fracture of the arch of the fifth lumbar vertebra until we can find some other mode of origin of spondylolisthesis; and indeed this supposition seems to be the more justifiable, for it is adm itted that in by far the greater number of cases the anamnesis gives evidence that the spondylolisthesis commenced in a fracture. If the entire posterior transverse span of the arch of the fifth lumbar vertebra is still in its normal place, that is, not displaced forwards, and if it is either not ossified on to the sacral articular processes, or if it be, if there is no elongation in the inferior lumbar articular processes from behind forwards, we may then suppose a primary fracture of the interarticular portion of the arch of the fifth lumbar vertebra (no congenital spondylolysis existing at this place) ; but if the entire posterior transverse span of the arch of the fifth lumbar vertebra has moved forwards with the rest, and if its inferior articular process exhibits an elongation from tensions corresponding with this forward move- ment, I think that the idea of a primary fracture in the sacral articular processes with separation of the fragments from each other is more justifiable. Summarising what has been said, we may formulate the etiology of spondylolisthesis at the present time as follows— Olisthesis may exist— (1) On the ground of congenital lateral defect in the ossifi- cation of one or both sides of the arch of the fifth lumbar vertebra, especially in the interarticular portion of the arch (spondyloschizis interarticularis congenita arcus vertebralis). (2) On the ground of a primary fracture— {a) Of the sacral articular processes, if the posterior trans- verse span of the arch of the fifth lumbar vertebra is displaced forwards, and its inferior articular process exhibits a corresponding antero-posterior elongation. {!>) Of the interarticular portion of the arch of the fifth lumbar vertebra, if the posterior transverse span of the arch is not displaced forwards, but has remaiued in its normal position, and whether the lumbo-sacral joint is ankylosed or not. It lies with anatomists and pathological anatomists, and with