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Not to be confused with spondylosis, spondylitis, or spondylolysis.
Spondylolisthesis
SpondylolisthesisL5S1.jpg
X-ray of the lateral lumbar spine with a grade III spondylolisthesis at the L5-S1 level.
Classification and external resources
Specialty Orthopedics
ICD-10 M43.1, Q76.2
ICD-9-CM 738.4, 756.12
OMIM 184200
DiseasesDB 12318
MedlinePlus 001260
eMedicine radio/651
Patient UK Spondylolisthesis
MeSH D013168

Spondylolisthesis is the forward displacement of a vertebra, especially the fifth lumbar vertebra, most commonly occurring after a fracture. Backward displacement is referred to as retrolisthesis.

The variant "listhesis," resulting from division of this compound word, is sometimes applied in conjunction with scoliosis.[unreliable medical source?][1] These "slips" occur most commonly in the lumbar spine. Spondylolysis (a defect or fracture of the pars interarticularis of the vertebral arch) is the most common cause of spondylolisthesis, which should not be confused with a spinal disc herniation (often misleadingly referred to as a "slipped disc"), in which one of the spinal discs in between the vertebrae has ruptured.

A hangman's fracture is a specific type of spondylolisthesis where the second cervical vertebra (C2) is displaced anteriorly relative to the C3 vertebra due to fractures of the C2 vertebra's pedicles.

Classification[edit]

Spondylolisthesis is categorized into five types:[2]

  • Isthmic spondylolisthesis is the most common form; also called spondylolytic spondylolisthesis, it occurs with a reported prevalence of 5–7 percent in the US population. A slip or fracture of the intravertebral joint is usually acquired between the ages of 6 and 16 years, but remains unnoticed until adulthood. Roughly 90 percent of these isthmic slips are low-grade (less than 50 percent slip) and 10 percent are high-grade (greater than 50 percent slip).[2] It is divided into three subtypes:[3]
    • A: pars fatigue fracture
    • B: pars elongation due to multiple healed stress fx
    • C: pars acute fracture
  • Degenerative spondylolisthesis is a disease of the older adult that develops as a result of facet arthritis and joint remodeling. Joint arthritis, and ligamentum flavum weakness, may result in slippage of a vertebra. Degenerative forms are more likely to occur in women, persons older than fifty, and African Americans.[2]
  • Traumatic spondylolisthesis is rare and results from acute fractures in the neural arch, other than the pars.[4]
  • Pathologic spondylolisthesis has been associated with damage to the posterior elements[which?] from metastases or metabolic bone disease. These slips have been reported in cases of Paget's disease of bone, tuberculosis, giant-cell tumors, and tumor metastases.[5]
  • Dysplastic spondylolisthesis is a rare congenital spondylolisthesis occurring because of a malformation of the lumbosacral junction, resulting in small, incompetent facet joints.[citation needed]

Signs and symptoms[edit]

Symptoms of spondylolisthesis include:[medical citation needed]

  • A general stiffening of the back and a tightening of the hamstrings, with a resulting change in both posture and gait.
  • A leaning-forward or semi-kyphotic posture may be seen, due to compensatory changes.
  • A "waddle" may be seen in more advanced causes, due to compensatory pelvic rotation due to decreased lumbar spine rotation.
  • A result of the change in gait is often a noticeable atrophy in the gluteal muscles due to lack of use.
  • Generalized lower-back pain may also be seen, with intermittent shooting pain from the buttocks to the posterior thigh, and/or lower leg via the sciatic nerve.

Other symptoms may include tingling and numbness. Coughing and sneezing can intensify the pain. An individual may also note a "slipping sensation" when moving into an upright position. Sitting and trying to stand up may be painful and difficult.[medical citation needed]

Treatment[edit]

Treatment of isthmic spondylolisthesis is controversial.[medical citation needed]

Conservative management[edit]

Patients with symptomatic isthmic spondylolisthesis are initially offered conservative treatment consisting of activity modification, pharmacological intervention, and a physical therapy consultation.

  • Physical therapy can evaluate and address postural and compensatory movement abnormalities.[medical citation needed]
  • Anti-inflammatory medications (NSAIDS) in combination with acetaminophen (Tylenol) can be tried initially. If a severe radicular component is present, a short course of oral steroids such as Prednisone or Methylprednisolone can be considered. Epidural steroid injections, either interlaminal or transforaminal, performed under fluoroscopic guidance can help with severe radicular (leg) pain. Lumbosacral orthoses may be of benefit for some patients but should be used on a temporary basis to prevent spinal muscle atrophy and loss of proprioception.

Surgical[edit]

Degenerative spondylolisthesis with spinal stenosis is one of the most common indications for spine surgery among older adults.[medical citation needed]

History[edit]

Spondylolisthesis was first described in 1782 by Belgian obstetrician Herbinaux.[6] He reported a bony prominence anterior to the sacrum that obstructed the vagina of a small number of patients.[7] The term “spondylolisthesis” was coined in 1854 from the Greek σπονδυλος = "vertebra" and "ὁλισθος" = "slipperiness," "a slip."[8]

Popular Culture[edit]

In the HBO television series The Sopranos, the character Salvatore Bonpensiero claims to suffer from spondylolisthesis when his loyalty to the family is cast into doubt.

See also[edit]

References[edit]

  1. ^ [unreliable medical source?]"Natural History of Adult Scoliosis". 
  2. ^ a b c "Adult Spondylolisthesis in the Low Back". American Academy of Orthopaedic Surgeons. Retrieved 9 June 2013. 
  3. ^ http://www.orthobullets.com/spine/2038/adult-isthmic-spondylolisthesis
  4. ^ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2843565/
  5. ^ http://www.basicspine.com/blog/spondylolisthesis-displacement-lower-spine-injury-age/
  6. ^ Newman PH (1955). "Spondylolisthesis: its cause and effect". Ann Coll Surg Engl 16: 305. 
  7. ^ Henry Jacques Garrigues (1902). A text-book of the science and art of obstetrics. pp. 490–93. 
  8. ^ "Isthmic Spondylolisthesis and Spondylolysis". 

Original courtesy of Wikipedia: http://en.wikipedia.org/wiki/Spondylolisthesis — Please support Wikipedia.
This page uses Creative Commons Licensed content from Wikipedia. A portion of the proceeds from advertising on Digplanet goes to supporting Wikipedia.

1548 news items

 
BMC Blogs Network
Fri, 05 Feb 2016 19:11:15 -0800

Their underlying diseases included 54 cases of spinal stenosis and 13 cases of spondylolisthesis. The patients were divided into two groups depending on the surgical level: group I (36 patients), who had undergone pedicle screw fixation and posterior ...
 
Becker's Orthopedic & Spine
Thu, 12 Nov 2015 08:07:58 -0800

The researchers surveyed Lumbar Spine Research Society members and AOSpine members for information about their preferred treatment for degenerative spondylolisthesis in multiple scenarios. There were 223 surgeons surveyed. The researchers found:.

Healio

Healio
Fri, 13 Nov 2015 23:25:56 -0800

The addition of interbody arthrodesis to posterolateral lumbar arthrodesis to treat L4-5 degenerative spondylolisthesis may just add expense and length of stay for a patient without any beneficial outcomes, according to a presenter at the International ...

CBS Local

CBS Local
Mon, 11 Jan 2016 06:55:23 -0800

Spondylolisthesis and spondylosis and radiculopathy. There are a lot of names that are thrown at people in terms of rationale of why they have back pain,” Dr. Dana Zalkind at New England Baptist's Pain Management Center, told WBZ NewsRadio 1030.
 
PR Newswire (press release)
Thu, 04 Feb 2016 14:18:45 -0800

LLIF is minimally invasive surgery recommended for treating lumbar spinal disorders such as spondylolisthesis, lumbar degenerative disc disease, scoliosis, and recurrent lumbar disc herniation. Technavio's analysts forecast the lateral lumbar interbody ...
 
Becker's Orthopedic & Spine
Thu, 06 Aug 2015 07:07:59 -0700

A new study published in Spine examines the national trends for degenerative spondylolisthesis surgical intervention. The researchers examined the National Inpatient Sample database for patients with degenerative spondylolisthesis that underwent lumbar ...

Stillwater Gazette

Stillwater Gazette
Wed, 20 May 2015 05:10:53 -0700

Welcome to my journey with Spondylolisthesis. A normal person's vertebrae overlap one another and fit together like a bunch of elongated “S” shapes (or tangent graphs if you know trigonometry). Spondylolisthesis is a condition when there is a slip of ...
 
Becker's Orthopedic & Spine
Tue, 26 Jan 2016 11:30:00 -0800

Blood loss was higher in patients with spondylolisthesis — 520 cc — compared with patients who didn't have spondylolisthesis — 103 cc. 3. Patients with transitional anatomy reported 347 cc of blood loss compared with 262 cc of blood loss among ...
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