What pattern of neural compression is most commonly associated with L5S1 isthmic spondylolisthesis

L5 nerve root compression (exiting nerve root of the L5-S1 motion segment) is the type of neural compression most commonly associated with L5-S1 isthmic spondylolisthesis. L5 nerve root compression may occur secondary to:

• Hypertrophy of fibrocartilage at the site of the pars defect (zone 1)

• Compression in the foraminal zone (zone 2) as the L5 root is compressed between a disc protrusion or osteophyte and the inferior aspect of the L5 pedicle

• Compression between the inferior aspect of the L5 transverse process and the superior aspect of the sacral ala (zone 3)

• Increased tension within the L5 nerve root secondary to forward displacement of the L5 vertebra

The sacral nerve roots can become involved in high-grade isthmic spondylolisthesis as these nerves become stretched over the L5-S1 disc and posterior aspect of the sacrum.

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