II. Definitions
- Spondylolisthesis
- Slippage of one Vertebrae over another
- L5 on S1 is the most common site
III. Types
- Degenerative Spondylolisthesis (adults)
- More common in women over age 40
- Isthmic Spondylolisthesis (children)
- Secondary to Spondylolysis
- More common in athletes (gymnastics, football)
IV. Symptoms
- Back pain radiates posteriorly into knees
- Hamstring spasms with inability to bend forward
- Limited Straight Leg Raise
- Bending, lifting or twisting provokes pain
V. Signs
- Loss of lumbar lordosis
- Flattening of buttocks
- Step-off at the affected spinous process (usually L5)
- Hamstring spasm
- Limited forward flexion
- Difficult Straight Leg Raise
VI. Imaging: Lateral Lumbosacral Spine XRay
- Position of posterior-inferior corner of involved Vertebrae (e.g. L5)
- Grading anterior slippage based on position over segment or Vertebrae immediately below (e.g. S1)
-
Vertebrae or sacral base (e.g. top of S1) is divided into 4 sections
- Grade 1: <26% slippage (posterior)
- Grade 2: 26-50% slippage
- Grade 3: 51-75% slippage
- Grade 4: 75-100% slippage (anterior)
- Grade 5: >100% slippage (Spondyloptosis)
- Consider flexion and extension views
- May demonstrate instability
VII. Monitoring
-
General
- Return for new neurologic symptoms or Cauda Equina Syndrome symptoms
- Adolescents
- Repeat XRay every 6 months until full adult height reached
VIII. Management
- Conservative management
- Avoid provocative activities (e.g. spine extension, squats)
- Encourage light activity (NOT bed rest) with Stretching
- Avoid heavy lifting
- Analgesics for pain
- Consider bracing
- Physical therapy
- Return to Play Guidelines
- Grade 1 Spondylolisthesis athletes may return to Contact Sports
- Grade 2 Spondylolisthesis athletes require sports medicine or spine evaluation prior to return to sports
IX. Management: Orthopedic or spine surgeon referral indications
- High grade slippage >50% (Grade 3 to 4)
- Failed medical management with persistent pain >6 months
- Instability (may require Spinal Fusion)
X. Prognosis
- Conservative, non-surgical management results in good to excellent longterm outcomes in >90% of athletes
XI. References
- Greene (2001) Musculoskeletal Care, p. 573-6
- Humphreys (2002) Am Fam Physician 65(11):2299-306 [PubMed]
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Related Studies
| Definition (MSH) | Forward displacement of a superior vertebral body over the vertebral body below. |
| Definition (CHV) | forward displacement of one vertebra over another |
| Definition (CHV) | forward displacement of one vertebra over another |
| Definition (CHV) | forward displacement of one vertebra over another |
| Concepts | Disease or Syndrome (T047) |
| MSH | D013168 |
| ICD10 | M43.1 , M43.10, M43.19 |
| SnomedCT | 157003009, 268349005, 274152003 |
| English | Spondylistheses, Spondylisthesis, Spondylolistheses, SPONDYLOLISTHESIS, Spondylolisthesis [Disease/Finding], Spondylolisthesis, site unspecified, spondylolisthesis, spondylisthesis, spondylolithesis, spondylolistheses, SPL - Spondylolisthesis, Spondylolisthesis (disorder), Spondylolisthesis NOS, Spondylolisthesis, Spondylolithesis |
| Dutch | spondylolisthese NAO, spondylolisthesis, Spondylolisthesis |
| French | Spondylolisthésis SAI, Spondylolisthèsis, Spondylolisthésis |
| German | Spondylolisthesis NNB, Spondylolisthesis |
| Italian | Spondilolistesi NAS, Spondilistesi, Spondilolistesi |
| Portuguese | Espondilolistese NE, Espondilolistese |
| Spanish | Espondilolistesis NEOM, espondilolistesis (trastorno), espondilolistesis, Espondilolistesis |
| Japanese | 脊椎すべり症ＮＯＳ, ｾｷﾂｲｽﾍﾞﾘｼｮｳNOS, ｾｷﾂｲｽﾍﾞﾘｼｮｳ, 脊椎逸出症, 脊椎すべり症, 脊椎辷り症 |
| Swedish | Kotförskjutning |
| Czech | spondylolistéza, Spondylolistéza, Spondylolistéza NOS |
| Finnish | Spondylolisteesi |
| Russian | SPONDILOLISTEZ, СПОНДИЛОЛИСТЕЗ |
| Korean | 척추탈위증 |
| Croatian | SPONDILOLISTEZA |
| Polish | Kręgozmyk |
| Hungarian | Spondylolisthesis k.m.n., Spondylolisthesis |
| Norwegian | Spondylolistese, Virvelforskyvning |
Ontology: Degenerative spondylolisthesis (C0264184)
| Concepts | Disease or Syndrome (T047) |
| SnomedCT | 203684005, 4046000 |
| English | degenerative spondylolisthesis, spondylolisthesis degenerative, Degenerative spondylolisthesis, Degenerative spondylolisthesis (disorder), degenerative; spondylolisthesis, spondylolisthesis; degenerative |
| Dutch | degeneratief; spondylolisthesis, spondylolisthesis; degeneratief |
| Spanish | espondilolistesis degenerativa (trastorno), espondilolistesis degenerativa |
Ontology: Isthmic spondylolisthesis (C0410656)
| Concepts | Disease or Syndrome (T047) |
| SnomedCT | 203683004 |
| English | isthmic spondylolisthesis, Isthmic spondylolisthesis, Isthmic spondylolisthesis (disorder) |
| Spanish | espondilolistesis ístmica (trastorno), espondilolistesis ístmica |
Ontology: Spondyloptosis (C0410658)
| Concepts | Disease or Syndrome (T047) |
| SnomedCT | 316916000, 240222001 |
| English | [Q] Spondyloptosis, [Q] Spondyloptosis (qualifier value), Spondyloptosis, Spondyloptosis (disorder) |
| Spanish | [Q] espondiloptosis, [Q] espondiloptosis (calificador), espondiloptosis (trastorno), espondiloptosis |
