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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] 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]

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

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]

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.

1008 news items

 
Becker's Orthopedic & Spine
Tue, 30 Jun 2015 08:33:45 -0700

The North American Spine Society released evidence-based guidelines for diagnosing and treating adult isthmic spondylolisthesis. "Staying current on research in the growing field of spine care is tough for today's busy spine specialists," said D. Scott ...
 
Healio
Mon, 29 Jun 2015 12:52:16 -0700

Researchers analyzed the differences between decompression alone and decompression with fusion in the presence or absence of the facet effusion sign in 160 patients with lumbar degenerative spondylolisthesis (LDS) identified from the Spine Center ...

Stillwater Gazette

Stillwater Gazette
Fri, 05 Jun 2015 14:45:00 -0700

Braden Cousineau, a junior at Stillwater Area High School, now has bolts and hardware ensuring his vertabrae won't slip into misallignment again. Without surgery, doctors said he would have been paralyzed from the waist down. (Submitted photo).
 
MarketWatch
Wed, 01 Jul 2015 13:37:30 -0700

AUDUBON, Pa., Jul 01, 2015 (BUSINESS WIRE) -- Globus Medical, Inc. GMED, +0.62% a leading musculoskeletal implant manufacturer, announced the introduction of RISE®-L, a lateral lumbar interbody fusion (LLIF) device and the latest addition to the ...

Ventura County Star

Ventura County Star
Wed, 01 Jul 2015 15:07:30 -0700

Each week, Calderone's practice sees about 50 patients with orthopedic and spinal conditions including degenerated discs, degenerative spondylolisthesis and scoliosis, and about five to 10 a week are admitted into surgery for herniated discs, spine ...

Stillwater Gazette

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

Spondylolisthesis is a condition when there is a slip of one vertebrae from another. The vertebrae slip can come from one of two different causes: a fracture of the vertebrae or a deformity. In my case, it was a deformity. While I was developing in the ...

Salisbury Post

Salisbury Post
Mon, 15 Jun 2015 21:30:46 -0700

Spondylolisthesis is a condition where one vertebrae slides over the vertebrae below it, often occurring in the lumbar region. Wood still has a few hairline fractures in his L4 and L5 vertebrae. He said those will never go away although, to avoid ...
 
Becker's Orthopedic & Spine
Wed, 01 Apr 2015 09:24:42 -0700

A new study published in the Journal of Neurosurgery: Spine examines minimally invasive laminectomy for lumbar spinal stenosis patients, comparing those with preoperative spondylolisthesis to those without. There were 110 patients included in the study ...
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