Kinematic analysis of L4-L5 spinal segment with spondylolysis and different types of grade 1 spondylolisthesis: a nonlinear finite element study

Purpose: This work aimed to evaluate and characterize the motion of the fourth and fifth lumbar vertebrae functional spinal unit with spondylolysis and different types of grade 1 spondylolisthesis using the finite element method. Methods: Nine nonlinear three-dimensional finite element models were reconstructed from computed tomography scans to five educational fourth and fifth lumbar vertebrae models. The intervertebral disc was simulated in two conditions: four models with healthy discs and five models with degenerated discs. Each model consisted of two vertebrae divided into three bony parts, two endplates, an intervertebral disc and five ligaments. The flexion, extension, lateral bending and rotation loading conditions were simulated, and the ranges of motion were measured and plotted. Results: In flexion, compared to the baseline intact model, the most significant increase in the range of motion was experienced by the isthmic spondylolisthesis model, while in extension, a reduction in the range of motion was measured in both prolonged pars and unilateral pars defect and healthy disc models. In degenerated disc results, the unilateral pars defect and degenerative spondylolisthesis models had the lowest range of motion. No large differences were noticed in lateral bending results. Lastly, in axial rotation, the most significant increase in the range of motion was measured in the isthmic spondylolisthesis model, followed by the spondylolysis model and similarly, in the degenerated disc models. Conclusions: The isthmic spondylolisthesis displayed hypermobility in flexion and rota-tion. Moreover, the model with unilateral pars defect showed hypermobility in axial rotation only. Finally, hypomobility in all move-ments was noticed with the degenerative spondylolisthesis model.