L-Spine

Spondylolisthesis

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Spondylolisthesis, Degenerative Spondylolisthesis, Isthmic Spondylolisthesis, Spondyloptosis

  • See Also
  1. Back Pain
  • Definition
  1. Slippage of one Vertebrae over another
    1. L5 on S1 is the most common site
  • 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)
  • 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
  • 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
  1. Position of posterior-inferior corner of involved Vertebrae (e.g. L5)
    1. Grading anterior slippage based on position over segment or Vertebrae immediately below (e.g. S1)
  2. Vertebrae or sacral base (e.g. 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)
  3. Consider flexion and extension views
    1. May demonstrate instability
  • Monitoring
  1. Adolescents
    1. Repeat XRay every 6 months until full adult height reached
  • Management
  1. Avoid provocative activities (e.g. hyperextension, squats)
  2. Analgesics for pain
  3. Consider bracing
  4. Physical therapy
  • Management
  • Orthopedic or spine surgeon referral indications
  1. High grade slippage >50% (Grade 3)
  2. Failed medical management
  3. Instability (may require spinal fusion)
  • References
  1. Greene (2001) Musculoskeletal Care, p. 573-6
  2. Humphreys (2002) Am Fam Physician 65(11):2299-306 [PubMed]