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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
ICD-10 M43.1, Q76.2
ICD-9 738.4, 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 break or 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 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]

X-ray picture of a grade 1 isthmic spondylolisthesis at L4-5
MRI of L5-S1 spondylolisthesis

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]
  • 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.[3]
  • 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.[citation needed]
  • 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 interlaminarl 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]

X-ray of a grade 4 spondylolisthesis at L5-S1 with spinal misalignment indicated

Spondylolisthesis was first described in 1782 by Belgian obstetrician Herbinaux.[4] He reported a bony prominence anterior to the sacrum that obstructed the vagina of a small number of patients.[5] The term “spondylolisthesis” was coined in 1854 from the Greek σπονδυλος = "vertebra" and "ὁλισθος" = "slipperiness," "a slip."[6]

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.ncbi.nlm.nih.gov/pmc/articles/PMC2843565/
  4. ^ Newman PH (1955). "Spondylolisthesis: its cause and effect". Ann Coll Surg Engl 16: 305. 
  5. ^ Henry Jacques Garrigues (1902). A text-book of the science and art of obstetrics. pp. 490–93. 
  6. ^ "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.

826 news items

 
Healio
Thu, 26 Mar 2015 21:18:45 -0700

Luo and colleagues studied 37 consecutive patients younger than 18 years who had scoliosis (23 patients), congenital spine deformities (6 patients), kyphosis (5 patients) and spondylolisthesis (3 patients). The majority of the scans, which were done ...
 
LA Daily News
Tue, 24 Mar 2015 22:15:00 -0700

He has been plagued with spondylolisthesis, a back injury that is as uncomfortable as it sounds, and still played into his 40s. When he left the team and yet swung a golf club and put it on Instagram, he was slimed on the Internet, which, since he is ...

Lakers.com

Lakers.com
Tue, 24 Mar 2015 20:19:47 -0700

Nash: This back condition I've had, the original one — now I have about eight of them — but spondylolisthesis, I've been aware of since going into my third year in the league. To be able to play since till I was 40 years old, I've rode this thing way ...
 
Macon Telegraph (blog)
Sat, 28 Feb 2015 21:03:45 -0800

The sports trial that analyzed lumbar radiculopathy, lumbar spinal stenosis and degenerative spondylolisthesis is one of these trials that was conducted over two years with grant money totaling $15 million. The study includes patients who have been ...

News-Medical.net

Medical Xpress
Mon, 23 Mar 2015 02:56:15 -0700

... patients consider sexual activity "relevant" to their life quality, and patients who receive surgical treatment for spinal spondylolisthesis (DS) and spinal stenosis (SS)—common degenerative conditions most often occurring in older adults—were ...
 
Becker's Orthopedic & Spine
Tue, 17 Feb 2015 09:48:45 -0800

A study published in The Spine Journal compares the two treatment methods. There were 1,789 patients with low back pain considered, and 149 young patients with spondylolisthesis who followed up for at least one year included in the study. There were 87 ...
 
Becker's Orthopedic & Spine
Fri, 06 Mar 2015 08:06:32 -0800

A new study published in The Spine Journal examines workers compensation patients undergoing single-level posterolateral fusion for spondylolisthesis or degenerative disc disease. There were 889 patients involved in the study who underwent surgery with ...
 
Dallas Morning News (blog)
Thu, 12 Mar 2015 08:22:49 -0700

Harrison underwent two procedures for a herniated disk in his lower pack in 2013 after making just two starts. He returned in late April last year and made four starts before being diagnosed with spondylolisthesis, a condition in which a vertebra slips ...
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