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Spondylolisthesis

Last updated: May 4, 2020

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The term spondylolisthesis defines a condition in which the vertebral bodies slip forward in relation to the vertebrae beneath. Most commonly L5 slips over S1. The disease affects approx. 6–9% of the population. The condition most commonly occurs in children, adolescents, and in individuals > 50 years old. Risk factors are repetitive hyperextension of the spine (e.g., gymnastics), trauma, bone pathologies, or degenerative spine disease. Spondylolisthesis may be asymptomatic or cause lumbar pain on exertion, gait problems, radiculopathic pain, or urinary incontinence. In some patients a step-off at the lumbosacral area is palpable. Diagnosis is established through imaging. Most patients achieve good results with conservative treatment (e.g., physical therapy). Surgical treatment (e.g, vertebral fusion, decompression of the nerves) is reserved for patients with refractory cases and neurologic deficits. Overall, children and adolescents achieve better results than adults and elderly.

  • Affects up to 10% of the population
  • Most common in children < 6 years, 12–17 years (congenital and spondylolytic form) and adults aged > 50 years (degenerative form)
  • Sex: > (congenital and spondylolytic form); > (degenerative form)
  • Defect most commonly occurs in the lumbar spine (L5 in 80% of cases)

References:[1][2][3][4]

Epidemiological data refers to the US, unless otherwise specified.

References:[1]

  • Asymptomatic (∼ 90% of cases)
  • Chronic lumbar pain that worsens with exertion and/or when reclining
  • Gait problems (e.g., waddling gait)
  • Possibly urinary or bowel incontinence

References:[1]

  • Physical examination
    • Step-off sign: In advanced stages, a noticeable step-off at the lumbosacral area may be palpated or even seen when the patient is standing.
    • Straight leg raise test: A straight leg raise with the patient lying on the back causes pain and therefore triggers elevation of the entire trunk (to relieve the pain).
    • Tight, contracted hamstring muscles
    • Possible weakness and atrophy in lower legs; reduced sensation and reflexes
  • Radiologic examination:
    • Conventional x-ray of lumbosacral spine
      • Indication: to evaluate the vertebral structures, the degree and severity of forward slippage, the slip angle, and the presence of concomitant spine pathologies
      • Usually spondylolisthesis is an incidental finding.
      • Specific signs:
  • CT scan: used to rule out other causes of pain (e.g., tumor), in traumatic cases, and to guide surgical treatment.
  • MRI: helps visualize the compression of the nerve roots

References:[5]

References:[1]

The differential diagnoses listed here are not exhaustive.

The main goals in the treatment of spondylolisthesis are to reduce pain, restore the mobility of the spine, and prevent further disease progression.

References:[1][5]

  • Conservative treatment gives satisfactory results in 80% of cases.
  • The rate of success from surgical treatment is higher in children than in adults.

References:[6][7][8][9]

  1. Vokshoor A. Spondylolisthesis, Spondylolysis, and Spondylosis. Spondylolisthesis, Spondylolysis, and Spondylosis. New York, NY: WebMD. http://emedicine.medscape.com/article/1266860-overview#a11. Updated: February 3, 2017. Accessed: February 16, 2017.
  2. Kalichman L, Kim DH, Li L, Guermazi A, Berkin V, Hunter DJ. Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population.. Spine (Phila Pa 1976). 2009; 34 (2): p.199-205. doi: 10.1097/BRS.0b013e31818edcfd . | Open in Read by QxMD
  3. Tebet MA . Current concepts on the sagittal balance and classification of spondylolysis and spondylolisthesis. Revista Brasileira de Ortopedia. 2014; 49 (1). doi: 10.1016/j.rbo.2013.04.011 . | Open in Read by QxMD
  4. Perrin AE. Lumbosacral Spondylolisthesis. Lumbosacral Spondylolisthesis. New York, NY: WebMD. http://emedicine.medscape.com/article/2179163-overview#a6. Updated: February 1, 2016. Accessed: February 28, 2017.
  5. Froese BB. Lumbar Spondylolysis and Spondylolisthesis. Lumbar Spondylolysis and Spondylolisthesis. New York, NY: WebMD. http://emedicine.medscape.com/article/310235. Updated: February 18, 2016. Accessed: February 16, 2017.
  6. Frennered AK, Danielson BI, Nachemson AL.. Natural history of symptomatic isthmic low-grade spondylolisthesis in children and adolescents: a seven-year follow-up study.. J Pediatr Orthop. 1991; 11 (2): p.209-13.
  7. Saraste H. Long-term clinical and radiological follow-up of spondylolysis and spondylolisthesis. J Pediatr Orthop. 1987; 7 (6): p.631-8.
  8. Seitsalo S, Osterman K, Hyvãrinen H, Tallroth K, Schlenzka D, Poussa M.. Progression of spondylolisthesis in children and adolescents. A long-term follow-up of 272 patients. Spine (Phila Pa 1976). 1991; 16 (4): p.417-21.
  9. Floman Y. Progression of lumbosacral isthmic spondylolisthesis in adults. Spine (Phila Pa 1976). 2000; 25 (3): p.342-7.
  10. Osterman K, Schlenzka D, Poussa M, Seitsalo S, Virta L. Isthmic spondylolisthesis in symptomatic and asymptomatic subjects, epidemiology, and natural history with special reference to disk abnormality and mode of treatment.. Clin Orthop Relat Res. 1993 : p.65-70.
  11. Tebet MA. Current concepts on the sagittal balance and classification of spondylolysis and spondylolisthesis. Rev Bras Ortop. 2014; 49 (1): p.3-12. doi: 10.1016/j.rboe.2014.02.003 . | Open in Read by QxMD
  12. Matz PG, Meagher RJ, Lamer T, et al. Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis. The Spine Journal. 2016; 16 (3): p.439-448. doi: 10.1016/j.spinee.2015.11.055 . | Open in Read by QxMD
  13. Samuel AM, Moore HG, Cunningham ME. Treatment for Degenerative Lumbar Spondylolisthesis: Current Concepts and New Evidence. Current Reviews in Musculoskeletal Medicine. 2017; 10 (4): p.521-529. doi: 10.1007/s12178-017-9442-3 . | Open in Read by QxMD
  14. Andrew ST, Porter DO. Spondylolisthesis. In: Giangarra CE, Manske RC, eds. Clinical Orthopaedic Rehabilitation. Elsevier ; 2017.
  15. Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. European Spine Journal. 2007; 17 (3): p.327-335. doi: 10.1007/s00586-007-0543-3 . | Open in Read by QxMD