Spondylolisthesis

Aka: Spondylolisthesis, Degenerative Spondylolisthesis, Isthmic Spondylolisthesis, Spondyloptosis

1. See Also
   1. Back Pain
2. Definition
   1. Slippage of fifth lumbar Vertebrae on s1
3. Types
   1. Degenerative Spondylolisthesis (adults)
      1. More common in women over age 40
   2. Isthmic Spondylolisthesis (children)
      1. Secondary to Spondylolysis
      2. More common in athletes (gymnastics, football)
4. Symptoms
   1. Back pain radiates posteriorly into knees
   2. Hamstring spasms with inability to bend forward
   3. Limited Straight Leg Raise
   4. Bending, lifting or twisting provokes pain
5. Signs
   1. Loss of lumbar lordosis
   2. Flattening of buttocks
   3. Step-off at the affected spinous process (usually L5)
   4. Hamstring spasm
      1. Limited forward flexion
      2. Difficult Straight Leg Raise
6. Radiology: Lateral Lumbosacral Spine XRay
   1. Position of posterior-inferior corner of L5
      1. Grading anterior slippage based on position over S1
7. . Sacral base (top of S1) is divided into 4 sections
   1. Grade 1 <26% slippage (posterior)
   2. Grade 2 26-50% slippage
   3. Grade 3 51-75% slippage
   4. Grade 4 75-100% slippage (anterior)
   5. Grade 5 >100% slippage (Spondyloptosis)
8. Monitoring
   1. Adolescents
      1. Repeat XRay until full adult height reached q6 months
9. Management
   1. Avoid provocative activities (e.g. hyperextension)
   2. Analgesics for pain
   3. Consider bracing
   4. Physical therapy
10. Orthopedic or spine surgeon referral indications
    1. High grade slippage >50%
    2. Failed medical management
11. References
    1. Greene (2001) Musculoskeletal Care, p. 573-6
    2. Humphreys (2002) Am Fam Physician 65(11):2299-306